[di meliora]

Ronald Pies, MD, is Editor-in-Chief Emeritus of Psychiatric Times, and a professor in the psychiatry departments of SUNY Upstate Medical University and Tufts University School of Medicine. His article, Antidepressants and the Sound of One Hand Clapping, is about faith. He explains:

From my perspective, we are witnessing what might be called a crisis of faith in the realm of antidepressant treatment. Now, “faith” is a curious term. It may imply something like “confidence”—or something more akin to “deep religious conviction.” My experience with a few recent blog postings has convinced me that both interpretations apply to the state of antidepressant research and treatment.

First, there is the issue of confidence, with respect to the efficacy of antidepressants (ADs) in both acute treatment studies and studies of long-term prophylaxis. (“Efficacy” usually refers to benefit under controlled, clinical conditions; “effectiveness,” to naturalistic settings). It turns out that the reported efficacy of ADs in acute treatment studies is, to a large degree, in the eye of the beholder—or of the statistical analyst. A great deal depends, for example, on how much stock we put in a 2- or 3-point change on the Hamilton Depression Rating Scale (HDRS, commonly known as the HAM-D) and how we understand the nature of the “placebo response.” http://www.searchmedica.com/resource...ue&ds=0&srid=3

After years of treatment, I finally figured out being a passive participant in my treatment was not working. I believed it when I was told after a little work here and a little work there, I was going to be all better. I did not get better, just more cynical.

Being more active in my treatment I think was something I needed to do. I still did not fully appreciate that being active meant more than deciding the topic of discussion at a session or asking about increasing the dosage of a medication. I just became more frustrated at the lack of progress.

When I was told I may not get better, I at last got past thinking a better therapist or a different medication was the answer. Being active came to mean taking full responsibility for my well-being. It was only then that I started to get better. I had been clapping with one hand.

Dr. Pies does an excellent job of encapsulating the debate over the efficacy of antidepressants. He does not state the public has been preyed upon by flimflam men, as I believe. He does say:

And so, overall, what is my verdict on antidepressants? In my estimation, our present medications for depression are only mediocre. For moderate to severe, and especially melancholic, cases of major depression, ADs are effective and sometimes lifesaving, particularly when part of a comprehensive treatment plan that includes psychotherapy. And, there is convincing evidence that ADs prevent relapse at least during the 6 months or so after a bout of major depression. For mild, non-melancholic cases of depression, I generally favor beginning with psychotherapy, given the “costs” of antidepressant side effects. In this regard, we urgently need to find antidepressants that are more effective and better tolerated. Recent research suggests that agents that modulate the N-methyl-D-aspartate (NMDA) system (eg, ketamine(Drug information on ketamine)) are worth further exploration.24 In sum: I do not hear loud applause for our current antidepressant armamentarium. I believe I hear the sound of one hand clapping.

So what is next? We need to improve access to psychiatric care, so that patients who need antidepressants are seen by those best trained and most knowledgeable in their use. We need to work more closely with our colleagues in primary care, so that they become more proficient in the diagnosis and treatment of depression. We need to investigate carefully even the very rare side effects of antidepressants, so that we do not lose the confidence of the general public. We need to avoid even the appearance of conflicts of interest, related to “Big Pharma.” And perhaps most important, we need to listen attentively and respectfully when our patients tell us they are not happy with their treatment.

Dr. Pies' article leaves me with a lot of ambivalence. On the one hand, I am outraged by the endless hype about the benefits of treatment that many see little of. On the other, I appreciate more the work of dedicated professionals who make a difference in the lives of so many despite the handicaps.

[phoenix7]

two things stand out to me

being more active in your own care -

and OMG i forgot lol my memory sucks - let me go back and see lol

oh yes - that they need ot listen attentively when we say we are not happy

therapy was good for me and took me a long way - i think although the anti depressants stopped me from feeling suicidal when i didnt have a T that was a good fit - in the long run i feel they slowed my recovery - not feelingthe feelings and dealing with them at the time
except the overwhelming ones that broke through

although wihtout the anti depressants i dont know if i would have coped initially as i didnt find a helpful T for over a year after i was attacked andgot PTSD and Depression

have i muddied the waters ? I hope not - i think that seeing anti depressants as the pot of gold at the end of the rainbow - and as my pdoc said somthing i would be on forever - is just not a good idea.

take care everryone - be well P7

[di meliora]

I see I omitted to include a link to the article, for which I apologize: http://www.psychiatrictimes.com/blog...ceRecrawl:%200

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[LogicandJeans]

This article makes me remember when I finally got the courage to go and see a doctor about depression. I wasn't sure I had it. I just knew I was having nightmares every night, couldn't sleep, didn't like myself much and was feeling really crappy. The doctor asked me a lot of questions until I cried, then he said he would prescribe me anti-depressants which would make me feel better. He didn't refer me to a psychologist or psychiatrist. Just said here you go, this will fix things, goodbye. They were my hope, so when everything just got worse and I stopped being able to eat and function in the next few days, I lost all hope. They were meant to fix things and they didn't. Nobody told me they would have any side affects.

I was just told I was put on the wrong anti-depressants and I was changed to Effexor. They worked for about 6 months and then I started to feel depressed again, so my psychiatrist (I had been referred to one after things got really bad) upped my dose. It took me about another year to realise that the anti-depressants were making me more depressed and unable to get out of it. They were also getting in the way of me being able to think and use any coping techniques that I had learnt. So I started to taper off. Then I found out that Effexor is really addictive. I had severe withdrawal symptoms, even by tapering off really slowly which included nausea, agitation, lightheadedness and inability to stay out of bed for more than 20 minutes without feeling sick. Nobody told me that they were addictive. There are even websites about it and a petition as this particular anti-depressant is known to be really hard to get off, but they still won't warn people.

I would never touch anti-depressants again after that. I felt much better when I got off them. I still get my downs, but I can get out of them myself. I am having a down right now and it's been going on for quite awhile now. I can't make it go away, but I can keep myself out of the really dark place where I can't function and might hurt myself. That's the best I can ask for right now until I can find something to make myself feel happy again. I dunno, maybe I should do a writing project or something. Something to be proud of... *shrugs*