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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Phillipa on January 27, 2013, at 18:24:59
I guess even docs in other countries disagree on the best treatment for depression & when "low" mood meets the criteria for using meds for this. Phillipa
Physicians Go Head to Head in Antidepressant Overuse DebateCaroline Cassels
Jan 22, 2013
Antidepressants are prescribed too easily, for too long, and have few, if any, beneficial effects.
That's one side of a head-to-head debate over rising prescription rates for antidepressants put forward by general practitioner Des Spence, MB, ChB, and published online January 22 in BMJ.
On the other side of the argument, psychiatrist Ian Reid, PhD, professor of psychiatry, University of Aberdeen, Scotland, maintains that the claim that antidepressants are overprescribed requires "careful consideration," asserting that the increase in prescriptions is due to small, but appropriate, increases in duration of treatment rather than more patients being treated.
For his part, Dr. Spence points out that the current definition of clinical depression, defined in both the fourth and the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as 2 weeks of low mood, is "too loose and is causing widespread medicalization."
He also claims that 75% of those who write the definitions have links to drug companies.
"Mental illness is the drug industry's golden goose: incurable, common, long term, and involving multiple medications. This relation with industry has engrained a therapeutic drug mindset to treat mental illness," he writes.
Dr. Spence notes that guidelines from the National Institute for Health and Clinical Excellence do not support the use of antidepressants for mild depression or necessarily for moderate depression, favoring instead psychological talk-based therapies.
"But even if we accept that antidepressants are effective, a Cochrane review suggests that only 1 in 7 people actually benefits," Dr. Spence writes.
Dr. Spence believes there is a lack of evidence to show that depression is undertreated and that antidepressant medications are used appropriately.
The only explanation for the rise in antidepressant prescriptions, which increased by almost 10% in 2011, is "that we are prescribing more antidepressants to even more people."
Lack of Evidence
But Dr. Reid disagrees. The idea, he writes, that GPs are handing out antidepressants "like sweeties" is not borne out by research.
He notes that a study conducted by his team that screened 1000 general practice patients for depression and that examined antidepressant prescription decisions of 33 GPs showed that physicians were "cautious and conservative In their prescribing for those that they did diagnose. We found only 3 patients for whom the indication was unclear."
He noted that the study's finding was instrumental in persuading the Scottish government to withdraw a target to reduce prescribing by 10%.
He notes that talk therapies are "at best" as effective as antidepressant medications but are not superior to them, adding that "effect sizes for psychological therapies may be smaller."
"Antidepressants are but one element available in the treatment of depression, not a panacea. Like 'talking treatments' (with which antidepressants are entirely compatible), they can have harmful side effects, and they certainly don't help everyone with the disorder. But they are not overprescribed," Dr. Reid writes.
Dr. Spence has disclosed no relevant financial relationships. Dr. Reid reports that he has received payment to deliver presentations at meetings organized by AstraZeneca and from Sanofi to attend an advisory board.BMJ. Published online January 22, 2012
Posted by Phil on January 27, 2013, at 19:27:25
In reply to Docs Disagree on Overuse Of AD's For Depression, posted by Phillipa on January 27, 2013, at 18:24:59
Presentations that doctors give are no more than motivational sales presentations. I was in sales a long time, it's exactly the same.
Posted by Phillipa on January 27, 2013, at 21:43:05
In reply to Re: Docs Disagree on Overuse Of AD's For Depression, posted by Phil on January 27, 2013, at 19:27:25
Phil so not good to take then. Yes the drug manufacturers are biased. Phillipa
Posted by Phil on January 27, 2013, at 21:47:42
In reply to Re: Docs Disagree on Overuse Of AD's For Depression » Phil, posted by Phillipa on January 27, 2013, at 21:43:05
I've always taken what the docs are pushing.
Posted by Phil on January 27, 2013, at 21:49:01
In reply to Re: Docs Disagree on Overuse Of AD's For Depression » Phil, posted by Phillipa on January 27, 2013, at 21:43:05
They say an 'expert' is anyone further away than 50 miles from the meeting.
Posted by Phillipa on January 27, 2013, at 21:57:04
In reply to Re: Docs Disagree on Overuse Of AD's For Depression » Phillipa, posted by Phil on January 27, 2013, at 21:49:01
I do agree!!!! Phillipa
Posted by jono_in_adelaide on January 28, 2013, at 16:49:16
In reply to Docs Disagree on Overuse Of AD's For Depression, posted by Phillipa on January 27, 2013, at 18:24:59
"Mental illness is the drug industry's golden goose: incurable, common, long term, and involving multiple medications"
I think the doctors used to say about dermatology, it was great financialy, because the patients never die, and they never get better. I guess thats true of psychiatry as well.
Posted by Phillipa on January 28, 2013, at 18:48:08
In reply to Re: Docs Disagree on Overuse Of AD's For Depression, posted by jono_in_adelaide on January 28, 2013, at 16:49:16
Jono dermatologists I've been told are the smartest overall hence they get into dermatology programs where others couldn't They get to set their own hours also. But they do deal with melanomas. Phillipa
Posted by baseball55 on January 28, 2013, at 19:19:25
In reply to Re: Docs Disagree on Overuse Of AD's For Depression » jono_in_adelaide, posted by Phillipa on January 28, 2013, at 18:48:08
> Jono dermatologists I've been told are the smartest overall hence they get into dermatology programs where others couldn't They get to set their own hours also. But they do deal with melanomas. Phillipa
Dermatology is apparently the most popular residency in the US. Rare emergencies, can make extra money on the side with botox and cellulose injections as well, in some cases, as doing plastic surgery. No insurance to deal with. Lots of bucks. Meanwhile, poor women can't get prenatal care and there is a shortage of GPs.
As far as psychiatric patients never getting better, that might be true of many on this list but it is not true in general. Most patients do graduate and go on with their lives.
Posted by jono_in_adelaide on January 28, 2013, at 19:21:08
In reply to Re: Docs Disagree on Overuse Of AD's For Depression » jono_in_adelaide, posted by Phillipa on January 28, 2013, at 18:48:08
I think SSRI's in particular are handed out a bit too frely, but, a good percentage of the population has neuroitc/anxiety related issues, and SSRI's are the safest means of giving them releif, so perhaps the prescriptions are justified in the real world, where family doctors are faced with patients who need help
Posted by Phillipa on January 28, 2013, at 21:12:37
In reply to Re: Docs Disagree on Overuse Of AD's For Depression, posted by baseball55 on January 28, 2013, at 19:19:25
The dermatologists I have seen take my medicaire & supplemental insurances. Are you thinking of plastic surgeons? I have to go every few months for skin checks and also get precancerous lesions frozen off my body. He's also done biopsies on some. I think probably they would see someone with an emergency rash? Phillipa
Posted by Phillipa on January 28, 2013, at 21:14:23
In reply to Re: Docs Disagree on Overuse Of AD's For Depression, posted by baseball55 on January 28, 2013, at 19:19:25
Baseball forgot that I think it's also true that a vast majority of people take a med for a short time and then are able to stop taking it. Phillipa
This is the end of the thread.
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