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Re: Starting Parnate after 15 yrs treatment-resistance baseball55

Posted by Robert_Burton_1621 on February 10, 2015, at 22:27:28

In reply to Re: Starting Parnate after 15 yrs treatment-resistance, posted by baseball55 on February 5, 2015, at 19:06:58

> I frequently see things in various media saying that "depression is highly treatable." Also that depression is very common - one in three people will suffer at some point in their life. The story seems to be that it's okay to be depressed and not something you need to hide because lots of people get depressed. And if you feel blue, you shouldn't suffer in silence but should pack yourself right off to the doctor who can prescribe meds that will make you better.
>
> I wonder how much of this is propaganda (especially from the drug companies) and how much is because, as depression loses its stigma, more people decide they have it and seek treatment. At least half the people I know take AD's. And most of them have never seemed to me to be the least bit depressed. At least not depressed like I've been depressed. Is that because their meds work, so I've only seen them well? Or because they weren't really clinically depressed but just feeling kind of blah and stressed out by things going on in their lives?
>
> I should also mention that (while I know that psychiatrists have their own problems) virtually everyone I know on ADs - and I'm talking at least 20 people - get them from PCPs and have never seen a psychiatrist. They go in for a check-up, say I've been feeling kind of depressed lately, get a scrip for prozac or wellbutrin, get better over time, then continue taking the med for years.
>
> I know that studies find response rates fairly low for true MDD. But if you look at all the people who are taking ADs and ask them how they feel, I imagine a good proportion of them will say, much better thank you.

Everything you say strikes me as very plausible, baseball.

As it happens, I came across an article in the Guardian today by Professor Peter Gotzsche.

http://www.theguardian.com/commentisfree/2014/apr/30/psychiatric-drugs-harm-than-good-ssri-antidepressants-benzodiazepines

In that article he states that "many of these drugs" (by which he means, I infer from the context, the SSRIs) "benefit only one out of ten people with severe depression".

It is unclear whether his observations on anti-depressant efficacy (or inefficacy) are restricted to the SSRIs etc. They are the only class of drugs he mentions explicitly. The sub-editors have had a hand, I'd surmise, in writing the headline ("Psychiatric drugs are doing us more harm than good"); more catchy and sensationalist than the more accurate "SSRIs....".

I'm not familiar with the background of Gotzsche's research, but what he states in the article is not inconsistent with the proposition that the practice of psychiatry is affected by a paradox of over-diagnosis and undertreatment.

See,e.g., Leon, "Paradoxes of US Psychopharmacology Practice in 2013: Undertreatment of Severe Mental Illness and Overtreatment of Minor Psychiatric Problems" J Clinical PsychoPharm 34(2014)545-548.

The Guardian has published a critical response to Gotzsche:

http://www.theguardian.com/commentisfree/2015/feb/11/are-antidepressants-outright-bad-for-you-it-depends

The writer (who is not a psychiatrist) makes some valid points, but falters, I think, on the assumption that "anti-depressants" should be treated as a homogenous class. Perhaps the beginning of wisdom in this area is to be scientifically scrupulous about distinguishing what class of anti-depressant is likely to be beneficial for a sub-type of serious depressive condition. Gordon Parker has been working on such topics in depressive nosology and pharmacology for years.

It's interesting to note that the writer's perspective, as a GP, gives some support to the hypothesis made earlier in this thread that responsibility for "over-diagnosis and undertreatment" lies with primary care medicine, not with psychiatry.

I'm not sure about that myself. But the anecdote the writer ends with - deciding against prescription of an anti-depressant to a patient who was reacting in distress at her diagnosis of breast cancer - is perhaps revealing in its implied premise that such a decision was really about a genuinely hard case.


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poster:Robert_Burton_1621 thread:1075968
URL: http://www.dr-bob.org/babble/20150129/msgs/1076243.html