Posted by dj on February 12, 2001, at 18:27:53
In reply to Thanks. (np) » willow, posted by Rzip on February 12, 2001, at 16:47:05
> > Check out the link DJ made below in his post "Active Treatment of Depression." You may
> be on the right path?
On his website (http://www.undoingdepression.com) Richard O'Connor makes both the case for and against ADs, as I suspect he does in his newest book on the "Active Treatment of Depression."
RZip I imagine you will revel in the very detailed analyis O'Connor lays out in the intro. and 1st Chapter as laid out at the url, cited below and I'd be interested to hear what your take is on it all. For those who are not inclined to fully engage in it here's an excerpt from the into. which provides a bit of an overview on O'Connor's take on things:
""I am a therapist who suffers from depression myself. I have tried to write something that will be practical and helpful to therapists, physicians, and pharmacologists who are trying to help patients who do not respond quickly or easily to the standard prescribed treatments. Unfortunately, research is confirming that these are the majority of people suffering from depression. As I did the literature review for this book, I found myself more and more concerned that most care for depression is superficial, inadequate, and based on false information. Many assumptions commonly held in the professional community—that newer antidepressants are reliably safe and effective, that short-term cognitive and interpersonal psychotherapy help most patients, that many people with depression can be effectively treated in primary care, that most patients can recover from an episode of depression without lasting damage—on close examination turn out not to be true at all. And practice based on these assumptions is not only inadequate for treatment of depression, it can actually exacerbate the disease.
Most therapists and psychopharmacologists can help a patient recover from a single episode of depression, but our relapse rate is far too high: Patients who have one episode of major depression are 50 percent likely to have another; patients who have three episodes are ninety percent likely to have more (Thase, 1999). And, if we are honest with ourselves, we will also admit that our batting average is not so good either; for every patient we can help, we probably see two whom we can't. Active Treatment of Depression suggests that we accept the idea that depression is a chronic disease, and that we help our patients plan their lives accordingly. Medications are usually helpful and often will be a part of the patient's life for some time to come, but rarely can they prevent future episodes and help the patient resolve the problems that led to trouble in the first place…
The ugly fact is that too much of treatment for depression only reinforces the disease. Any experienced therapist has encountered patients who have been damaged by previous treatment, sometimes by highly qualified practitioners. Analytic therapy has reinforced depression in some who become mired in rumination. Directive treatment has demoralized and shamed patients by sadistically attacking their defenses. Medication, even when effective, can reinforce passivity. ECT can do the same. Yet all of these approaches also can be beneficial, with the right patient at the right time. How do we understand this?
I urge the reader to accept the fact that no single theory can yet explain this complex condition that affects twenty percent of the population. In fact, trying to understand depression exclusively from a single perspective—for instance, a cognitive-behavioral, psychodynamic, or a biochemical point of view—will necessarily limit our understanding and our ability to help our patients. Rather, we must be willing to take the best knowledge from many different points of view and shape it into practice guidelines. In doing so, we must also practice "active treatment" because many of our customary ways of operating are counterproductive with depression...
.... Depression is more difficult to treat than we want to acknowledge. Everyone believes that research has demonstrated that cognitive behavioral therapy, interpersonal psychotherapy, and medication are demonstrably and equally effective in treating depression. But that was at three months after treatment. At eighteen months, not a single one of the patients, no matter what treatment they'd received, were any better off than the control group (Shea et al., 1992). In order to truly help people who are suffering with this venomous and insidious condition, we have to be willing to challenge some of the assumptions we hold dear. I hope the reader will bring an open mind. I have attempted to present a reasonably thorough and objective review of the current state of knowledge, and I hope that the result is both reliable and provocative.
Much of what is to follow is rather prescriptive. I don't want to gloss over the individual differences between patients and between therapists. Any therapeutic dyad is a highly unique entity. Each therapist is—or should be—struggling with his own uncertainty, how to help this patient in this situation given the limits of his professional knowledge, his incomplete understanding of the patient, the constraints of the therapeutic relationship, and individual biases and anxieties. I'm trying to give advice to the therapist based on my own perspective about depression, advice that hopefully informs and enlightens without ignoring the uniqueness of the patient-therapist situation and without ignoring the complex, unfathomable, potential of human existence. I do not believe it is helpful for our profession to pursue the belief that there is one, and only one, technically correct intervention at any given point in time in a therapeutic relationship. Rather, there are infinite interventions, some more helpful than others. But even the most helpful interventions have the effect of constraining the future dialogue, of co-constructing a reality that will have an impact on the future that is impossible to predict with reliability. When the patient has depression, that new, constructed reality must provide a different perspective: hope, alternatives, openings, even wisdom and power. To settle for less is to sell the patient short.."