Monday, June 20, 2011

Treating Depression: It’s Free, It’s Healthy, and It Works

Unhinged: The Trouble with Psychiatry - A Doctor's Revelations about a Profession in Crisis
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

Much useful but depressing material has been extracted from Robert Whitaker’s book: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. It was a pleasure to come across some material that brought a smile to my face. He presented some data that will lift my spirits for a long time.

One has justification in being dubious about the benefits that might be derived from the chemical antidepressants the drug companies are marketing. We reported here on the claim that the drug companies’ own data indicates that medications and placebos are equally effective. Whitaker now adds a delightful variation on that theme.

It is well known that a good workout generates some mood pleasing chemical changes in the brain, so it is not too surprising that someone would try to quantify this effect as it pertains to those suffering from depression. Below is a chart showing the results of a study performed at Duke University.

Three groups were assembled. One was treated with Zoloft, a common antidepressant drug, one was provided exercise therapy, and the third combined Zoloft and exercise. The results indicate that exercise alone works as well as medication in the short term and almost twice as well in the long term. The Zoloft not only doesn’t work as well, it seems to negate the benefits that might be derived from exercise.

Whitaker tells us that in the UK exercise therapy can be prescribed for patients suffering from depression.

“As might be expected, patients have found ‘exercise-on-prescription’ treatment to be quite helpful. They told the Mental Health Foundation that exercise allowed them to ‘take control of their recovery’ and to stop thinking of themselves as ‘victims’ of a disease. Their confidence and self-esteem increased; they felt calmer and more energetic. Treatment was now focused on their ‘health’ rather than their ‘illness’.”

This is consistent with the notion that effects derived from antidepressants are mainly a placebo effect. After implying, in previous posts, rather poor professional standards on the part of psychiatrists, I decided I ought to discover some of their opinions in order to get a more balanced perspective. I chose to read Daniel Carlat’s book: Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations about a Profession in Crisis. I confess I did not look for the most fervent defender of the profession, but this turned out to be a rather good book that will be discussed in the future.  We are interested in what Carlat believes to be the role of the placebo effect in treating depression. Here are a few quotes from Carlat.

“....if you ask any psychiatrist in clinical practice, including me, whether antidepressants work for their patients, you will hear an unambiguous ‘yes.’ We see people getting better all the time. True, much of this response is undoubtedly due to the placebo effect, but it would be deceptive for me to prescribe a sugar pill to my patients while telling them that it is a real medication. So I am stuck with prescribing active psychotropic drugs in order to activate the placebo, with the main disadvantage being that such drugs have far more side effects.”

“....a recent review of long-term antidepressant data found that the placebo response is much longer lasting than had been assumed. In fact, nearly 80 percent of placebo patients who entered long-term extension studies remained perfectly well for up to a year in such studies.”

Psychiatry has become a strange business with many ethical challenges. We will have more to say about Carlat’s excellent book.


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