Trusted Health Articles to Your Phone or Computer: MedCircle

→ August 3, 2017 - 1 Comment

Trusted Health Articles to Your Phone or Computer: MedCircle

MedCircle is a new phone app and website that allows you access to curated, high-quality, accurate, health-related articles. What does this mean? It means that instead of Googling “bipolar” and getting back a zillion trashy results from sources you can’t trust (a pet peeve of mine), you can get articles on bipolar disorder from sources that have been reviewed by medical experts.

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Should Mental Illness Funding Be Used on Addiction Treatment?

→ September 6, 2012 - 39 Comments

Should Mental Illness Funding Be Used on Addiction Treatment?

If you read the Breaking Bipolar blog over at HealthyPlace you might have seen a question earlier this week:

People have come down on both sides of this question on HealthyPlace and on Facebook but I think the overarching sentiment is that addiction is not just another mental illness as personal choices lead to its existence. No one causes bipolar disorder or schizophrenia through action but no one puts a drink in an alcoholic’s hand and forces them to imbibe. Moreover, addiction recovery is considerably simpler in that addicts get better by choosing not to use substances while other mental illness treatment involves months of treatment before any turnaround is seen and typically involves lifelong treatment. For addicts who are also suffering from a mental illness they are usually entered into an in-patient dual-diagnosis rehab program.

But whether you think that addiction (or, more specifically substance abuse and substance dependence) is simply another mental illness or not, there is this question:

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Drug Trials, Antidepressants and Placebo Effect – Is it Bad?

→ December 12, 2011 - 6 Comments

When drug trials are conducted, the gold standard (and requirement for FDA approval) is a double-blind placebo-controlled study. In this kind of drug study participants are randomly assigned to receive either the medication or an inert (does nothing) pill known as a placebo. Neither the doctor not the patient knows whether they are getting the placebo or the real drug.

The study then compares what happens to those who received the real drug versus those who received the placebo and determines the efficacy of the real drug.

The Placebo Effect

This is critical because of something known as the “placebo effect.” The placebo effect is this odd scenario where people get better just because you give them a pill, even if the pill does nothing. Doctors and scientists don’t understand the placebo effect but not only will people get better on a placebo, but they will even experience side effects – something that isn’t possible given that the placebo is inert. But the brain is a powerful thing and something we don’t fully understand.

Treatment vs. No Treatment OutcomesAnd one of the problems with antidepressants (and many medications) is that sometimes they aren’t better than the placebo. Additionally, sometimes when they are better than the placebo, it’s only by a small margin. Drug companies have to prove that their drug is statistically significantly better than a placebo in order to get FDA approval but even this statistically significant amount can be very small.

However, this isn’t a piece about how effective are when antidepressants are compared to placebos. This is a piece about how effective antidepressants are compared to no treatment.

Depression Treatment vs. No Treatment

Now, each disorder would have to be studied individually, but basically the question is, if you put treatment vs. placebo vs. no treatment, what would happen? ^

I can tell you what would happen – the people who received no treatment would do worse than those who received a placebo.

To the best of my knowledge there is no exact study like this, likely because it wouldn’t make it past an ethics board. If you determine a person is ill and needs treatment it is unethical to offer them none.

There is, however, a comparison of treatment vs. no treatment that I’m aware of. Here, they study people who have received treatment vs. those who have not. (They break down those who have not into three additional groups: those that don’t think they need treatment, those who think they need treatment but don’t get it, and those that don’t need treatment.) Note that “treatment” isn’t specified so it could be of any kind.

What they find for depression is that those who receive treatment go from around 30 to 24 on a depression scale in one year and those that need treatment but don’t get it go from about a 27 to 23 in one year (in both cases a higher number indicates greater depression).

So, treatment moves them 6 points and no treatment moves them 4 points. Approximately.*

No Big Deal?

Well, it depends if you’re the one depressed.

Firstly, it’s important to note that those in treatment were more depressed than those who weren’t. This should be noted as those people would likely have worse outcomes in one year. (The study wasn’t designed to take this into account but does note that symptom severity at outset is the biggest predictor of poor outcomes.)

Secondly, it’s worth noting that 2 points on a 35-point scale can lead to a significantly greater quality-of-life for the person in general. Many people with treatment-resistant depression I know would kill for that kind of improvement.

Thirdly, this improvement marker isn’t the only relevant one; it’s just the only one I have to go on.

Numbers on the kind of improvement seen in treatment versus no treatment vary, but everyone agrees that no treatment is worse. (The above estimate is rather conservative.)

What, No Placebo?

Unfortunately, no. There is no placebo in this study. Sorry.

But as we do know that people on a placebo do almost as well, and sometimes better, than those on the drug, we can guess (yes, guess; again, sorry) that people on a placebo would land somewhere in between the two above outcomes.

Question: How Do We Improve Outcomes without Giving a Placebo?

So the question is, if people on a placebo do better than no treatment (but not as well as those treated) then is there a way to preserve that gain? Doctors can’t prescribe placebos, it’s unethical.

Or is the placebo effect when being given an antidepressant such a bad thing? If, really, you respond to a real medication because of the placebo effect (and you wouldn’t know the difference, no one would) is that really all that bad? Does that not have a value?

People decry the placebo effect saying it proves that antidepressants are worthless. But I say how would all those people benefiting from them, even from the placebo effect, get better without them?

^ See the comment Placebo Effect in Depression as well. 

 * In case you were wondering, people who were depressed but didn’t think they had a problem were less depressed than those that perceived a need for treatment; however, they only moved down the scale from about 18 to 16 in one year.

Free rTMS, Brain Changes in Depressed Females, Why Anti-Benzodiazepine? – 3 New Things

→ September 29, 2011 - 4 Comments

Last week I didn’t post three new things but don’t take that to mean I wasn’t learning because I certain was, and always am. For this week I have these three new pieces of information to share:

  • Repetitive transcranial magnetic stimulation (rTMS) treatment for depression to be free for (some) Canadians
  • Brain changes are noted in depressed females
  • Why are some doctors anti-benzodiazepine?

1. Free rTMS in Manitoba (Canada)

RTMS stands for repetitive transcranial magnetic stimulation and is a treatment for treatment-resistant depression. RTMS is considered a neurostimulation therapy, like electroconvulsive therapy (ECT), but is non-invasive. RTMS has its pros and its cons.

  • Pros – rTMS is drug-free, has few side-effects and can produce remission from depression in some people
  • Cons – rTMS is expensive, intensive and its therapeutic effects are generally temporary

Cost of RTMS

Most people don’t get rTMS due to the cost. Repetitive transcranial magnetic stimulation requires 2 sessions per day for 10 days (weekends off) plus and additional possible 5-10 sessions depending on the reaction to treatment. Needless to say, this is one expensive therapy. In Canada that works out to $5000 – $7500 and in the States lord only knows how much.

Differences in Brains of Depressed WomenFree RTMS

And Manitoba is taking the very civilized step forward of offering rTMS as part of the public health care system, which is how it should be. The only reason why it isn’t is cost. You can get rTMS in Canada, but this is the first time I’ve heard of it being free.

Congratulations to Manitoba for taking a step forward in helping people with a mental illness. I hope this is the sign of things to come across the country.

2. Brain Changes Noted in Depressed Females

Women are twice as likely to develop depression as men but no one knows why. This study takes a look at female brains to look for biological identifying markers between depressed brains and well brains.

. . . depressed women had a pattern of reduced expression of certain genes, including the one for brain-derived neurotrophic factor (BDNF), and of genes that are typically present in particular subtypes of brain cells, or neurons, that express the neurotransmitter gamma-aminobutyric acid (GABA.) These findings were observed in the amygdala, which is a brain region that is involved in sensing and expressing emotion.

BDNF and GABA in Depressed Brains of Women

BDNF is something I’ve mentioned before as to a biological cause of depression. Yes, just another fact to chalk up for all the people saying depression is just “in your head.”

And work toward identifying the gene that contributes to depression:

. . . researchers tested mice engineered to carry different mutations in the BDNF gene to see its impact on the GABA cells. They found two mutations that led to the same deficit in the GABA subtype and that also mirrored other changes seen in the human depressed brain.

I keep telling people: We’re getting closer to effective treatments and understanding every day.

3. The Religion of Benzodiazepines – Why Some Doctors Don’t Prescribe Benzos

I’ve taken benzodiazepines (benzos) of one type or another for a decade and never once had a problem with them, but many people do develop tolerance, dependence and drug-seeking behavior around this type of medication.

My opinion is that benzodiazepine medications can be used quite safely when properly handled, but that some people have the tendency to get addicted to medications, and for them, these medications may be contraindicated. In other words, it’s down to the individual and prescription of benzos cannot be characterized as “bad” or “good” in a blanket statement.

I plan on writing a whole article about this, but if you’d like a sneak peek about why some doctors are anti-benzodiazepine, check out this article in Psychiatric Times.

Until next week all, when I shall learn more and do better.

Should Ecstasy (MDMA) be a Psychiatric Medication?

→ September 26, 2011 - 27 Comments

Should Ecstasy (MDMA) be a Psychiatric Medication?

You may not know this, but ecstasy (MDMA) has been studied as a psychiatric medication. Yes, that’s right, that stuff kids take at raves. The stuff that makes you thirsty and fall in love to the person next to you. That stuff. And MDMA was shown effective in several psychiatric uses.

But research on MDMA (ecstasy) was curtailed in 1985 when the US government named it a class 1 drug (like heroin) over the objections of doctors. Psychiatric research on MDMA is gearing up again though and it has shown promise in treating post-traumatic stress disorder (PTSD) and possibly depression and anxiety.

What is Ecstasy (MDMA)?

The active substance in ecstasy is MDMA (3,4-methylenedioxymethamphetamine). However, when ecstasy is purchased on the street, MDMA is common mixed with methamphetamines and other drugs.

So, to be clear, this means that while taking MDMA in a clinical setting may pose limited risk, taking it illicitly is a different risk profile altogether. I do not recommend you buy ecstasy off the street to treat mental illness. (Particularly if you suffer from bipolar 1 or any psychotic symptoms.)

Ecstasy Use in PsychotherapyHow Does Ecstasy (MDMA) Work?

The subjective effects of ecstasy (MDMA) are produced, in part, by a huge release of serotonin. This may be responsible for reducing the perception of threats and of negative emotions in others.

Ecstasy, MDMA, also increases levels of the neurohormones oxytocin, prolactin and cortisol. Oxytocin is thought to reduce feelings of fear and increase social affiliation and trust while cortisol is a stress hormone which may explain why some people experience anxiety while using MDMA.

How is Ecstasy (MDMA) Used in Psychiatry?

Interestingly, ecstasy is being used during psychotherapy and not as a psychopharmacological treatment, per se. MDMA is administered during elongated therapy sessions (8 hours) and patients work through emotions and memories that were impossible to handle beforehand. Two or three MDMA treatment sessions may be done with preparation therapy sessions beforehand and follow-up therapy sessions after.

Patients claim,

“. . . enhanced self-understanding [and] insight into personal patterns or problems, greater self-confidence or self-acceptance, lowered defenses [while] undergoing a therapeutic emotional process,” and “less negative thoughts or feelings.”

Studies on MDMA

Right now all the studies are on MDMA-treatment of post-traumatic stress disorder (PTSD) but look for other studies in the future. These studies on PTSD and ecstasy (MDMA) look extremely promising. Right now, several countries have completed phase one research and are onto phase two.

Risks of MDMA in Psychiatry

Risks vary depending on who you ask but in controlled, clinical use the risks of ecstasy (MDMA) appear to be minimal. While some worry about the effects on memory and cognition, some studies have shown there is no effect to these areas. There haven’t been enough participants in studies to make conclusive statements about MDMA risks.

My Thoughts on MDMA in Psychiatry

I’m very interested in such medications. MDMA works on the brain in a powerful way that other drugs do not. In this way ecstasy is unique and is hopeful for people with treatment-resistant disorders. I have a feeling that flooding the brain in this unusual way may be helpful in improving intractable disorders. This is mostly a hunch on my part, but I look forward to seeing what the future holds.


Psychiatric Times, Does MDMA Have a Role in Clinical Psychiatry? By Michael C. Mithoefer, MD, 06 May 2011

No Evidence of the Effectiveness of Psychotherapy? – 3 New Things

→ September 15, 2011 - 20 Comments

This week I learned three new things about psychotherapy and depression.

I’m a fan of psychotherapy for everyone. In fact, if we could get the mid-East folks to sit down for some good counselling, I think it would be more effective in bringing peace than anything you can do with a gun.

With that said, there are limitations to therapy and sometimes therapy is not all it’s cracked up to be. So this week, a look at three perspectives on psychotherapy:

  • Psychotherapy is no better than placebo in treating depression?
  • Which type of psychotherapy is better for depression?
  • How does psychotherapy change the brain?

1. Is Psychotherapy Better Than a Placebo in Treating Depression?

When the study came out  a couple of years ago alleging that antidepressants were no better at treating mild-to-moderate depression than a placebo, the antipsychiatry world went crazy (if you will). All their dire claims, it seems, had been proven true.

Well, the sky hasn’t fallen yet, but interestingly the same kind of analysis, when applied to psychotherapy, can also allege that psychotherapy is no better than a placebo too.

Can Psychotherapy Treat Depression?Placebo for Therapy

Of course, there is no such thing as a placebo in therapy. There is no “inert” counselling session. Scientific literature attempts to compare cognitive behavioural therapy (CBT), interpersonal therapy (IP) and others against wait-listed participants and those who have received therapy not containing the specific therapeutic technique being tested. Basically, they tell a therapist not to therapy. Which is a pretty tough thing to ask a human to do. And naturally, humans aren’t going to do it well.

Does Psychotherapy Work to Treat Depression?

I would say yes, therapy, various types, including cognitive behavioural, interpersonal and supportive therapy, all help treat depression. However, some suggest the jury is still out on how effective therapy really is in treating depression.

2. What Therapy is Best for Depression?

[push]Psychologist Gary Greenberg states CBT is more of an ideology and a “method of indoctrination into the pieties of American optimism.”[/push]

When selecting a therapy for depression one has many choices but the prevailing one in the scientific community right now is cognitive behavioural therapy (CBT). Everybody loves it. It’s the golden child. CBT is a highly intellectual and analytical therapy that is short-term and action-oriented so it’s no wonder that people like it.

In the same article as the one talking about therapy effectiveness in the treatment of depression, they also discuss which therapy is best for depression, and it kind of seems like none of the therapies are best. (This could be because, statistically, some people respond better to one treatment while others respond to other treatments and when you lump them all together, a similar percentage responds to each.)

3. What Does Psychotherapy Do to the Brain?

As I have mentioned several times, depression decreases brain volumes over time – ie, depression shrinks your brain. It does this through decreasing neurogenesis (the creation of new neurons); however, electroconvulsive therapy (ECT) and antidepressants have both been shown to increase neurogenesis and brain volume.

Interestingly, so does psychotherapy.

More on brain changes as a result of psychotherapy here.

Until next week all. I’ll learn more and do better.

New Antipsychiatry Discussion, L-Theanine, Rapid Cycling Markets – 3 New Things

→ September 1, 2011 - 2 Comments

This week’s three new things include:

  • A new supplement that may help brain health and mental illness: l-theanine
  • A poor comparison between rapid cycling bipolar disorder and the financial markets
  • A new discussion of antipsychiatry

1. New to Me: L-Theanine as an Antidepressant

Maurya, a commenter, asked if I knew anything about l-theanine. Well, I didn’t. Every once in a while even I run across something of which I haven’t heard.

So, for those of you in my boat, here’s a bit about l-theanine:

As always, as this is a supplement it is not FDA-controlled and there is no guarantee as to what you will get in the bottle and you should never take any supplement without first checking with your doctor.

More studies on l-theanine can be found here.

Rapid Cycling Brings Out Stigma Comments2. What I Don’t Like – A Half-Assed Comparison Between Bipolar Disorder and the Financial Markets

I’m a writer so questionable metaphors irk me. And rapid cycling bipolar disorder as a metaphor for the financial marketplace? Really? That’s a whole new level of irk.

If you really want to make that comparison then the bulk of the article should be on the markets and not mental illness, and not the other way around like Lloyd I. Sederer M. D. did in Rapid Cycling Bipolar Disorder: In the Office and On ‘The Street.’

Comments of Mental Illness Stigma

All this poorly-written article did was confuse people and elicit a bunch of anti-bipolar comments like:

“The foundation of the Bi-Polar epidemic is based in suppressed biochemist­ry, outdated understand­ing of genetics and a complete misunderst­anding of our true spiritual nature.”


“So how exactly is this different from saying some people dramatical­ly over-react to external circumstan­ces?

Sorry folks, but this one goes into the notebook for the next philosophi­cal discussion of “medicaliz­ation” as a way of discussing deviance.”

Seems to me he just wanted to use mental illness as an eyeball-grabber, tricking readers onto a topic they would never otherwise read – with the extra bonus of eliciting remarks of stigma.

Gee, thanks.

3. What I Find Interesting – New Discussion of Antipsychiatry

As you might know, I’m not a fan of antipsychiatry folks. I have written a lot on this topic and I’m sure I will write much more in times to come. But I can across this article, Getting It From Both Sides: Foundational and Antifoundational Critiques of Psychiatry which has an interesting discussion of antipsychiatry viewpoints.

Two Sides to Antipsychiatry

It astutely notes there are two sides of antipsychiatry – those who feel that nothing can be defined and thus no mental illness can be defined; and those who feel illness is rigidly defined and mental illness doesn’t meet that definition.

Both sides, as the author says,

“. . . have had the effect of discrediting and marginalizing psychiatry and of delegitimizing psychiatric diagnosis and nosology.”

It’s a very intelligent view of antipsychiatry criticism that is elevated far beyond what we normally see online. Check it out.

Until next week: Smarter and Better.

Linky-Madness, Drugging Children and Anxious Hat Makers – 3 New Things

→ August 25, 2011 - 4 Comments

In my line of work I come across the most obscure information, which is why I love sharing it with you. This week’s three new things about mental illness include:

  • A weekly mental health link-party
  • How scientists want to drug children who might get a mental illness
  • How hat makers used to experience social phobia

How could you not want to know the details about that?

1. What I Like – Madness Mental Health Linky

I’ve been participating for a few weeks in the Monday Madness Mental Health Linky over at the WordsinSynch blog by Shah Wharton. As the name implies, there are fresh links every Monday.

[push]Anyone can contribute a useful mental health link. Shah features her own work or the work of others and then lists useful links.[/push]

(No offence to Shah, but the layout is awful and kind of hard to understand.  Here’s how it works: Simply read the Monday Linky article and at the bottom there are featured links. Below that is the “blog hop” where the reader-submitted useful mental health links are posted and below that you can enter your own link.)

Click. Read. Enjoy.

2. What I Don’t Like – Drugging Children (or anyone unnecessarily)

Drugging Children with AntipsychoticsI could just leave it there but what I especially don’t like is the drugging of children who might get a mental illness. This is one of the troubles with that fad diagnosis I mentioned last weekpsychosis risk syndrome. While we do, honestly, know what puts a person at risk for psychosis, that’s a far cry from actually being able to accurately predict who is going to get a psychotic disorder.

For example, I know smoking puts you at risk for lung cancer, but you still might not get it. (Although smoking’s a lot more clear cut than psychosis. Don’t smoke. Seriously.)

In this study, people age 15-40 were to be given an antipsychotic (quetiapine) to see if it would delay or prevent the onset of a psychotic disorder like schizophrenia. And – here’s the kicker – up to 80% may never get the disorder anyway.

So I ask you, is it worth exposing a 15-year-old to a powerful antipsychotic associated with an increased mortality rate on a guess? I think not. (More next week.)

3. What is Just Bizarre – Hat Makers, Mercury  and Anxiety

Think you have social phobia? Do you make hats?

Excessive shyness, embarrassment, self-consciousness, timidity, social-phobia and lack of self-confidence are components of erethism, which is a symptom complex that appears in cases of mercury poisoning. Mercury poisoning was common among hat makers in England in the 18th and 19th centuries, as they used mercury to stabilize wool into felt fabric.

(From Wikipedia, where else?)

See you all next week for an attempt at a smarter and better me.

PS: Have you entered to win yet?

Alternative Medicine Resource, Fad Diagnoses, St. John’s Wort – 3 New Things

→ August 19, 2011 - 4 Comments

In today’s 3 New Things series I talk about:

1. What I Don’t Like – Fad Diagnoses in the DSM

Psychosis Risk Syndrome (AKA attenuated psychotic symptoms) and Temper Dysregulation (AKA disruptive mood dysregulation)

See, I’m not a scientist, and I honestly can’t tell you with any degree of certainty these conditions don’t exist or that they shouldn’t be specifically diagnosed. I just don’t think so, particularly as they may be pediatric diagnoses. The concern expressed in the article* is that these diagnoses have little scientific backing and will lead to yet a further increase in prescriptions of antipsychotics to children (and others) – and that I can tell you with certainty, that I am against.

There are many issues with the new version of the DSM, due out 2013, some positive, some negative, but honestly, if I started writing about them it would take until 2013 to finish. Best to take a millimetre at a time, I say

2. What I Do Like – Alternative Medicine Index from the University of Maryland

St. John's Wort no Better than Placebo in Treating Depression

From Wikipedia

I’m not a huge fan of alternative medicine, mostly because it, as a rule, doesn’t work. However, if you’re going to wander down that path, you need a reliable source of information and I believe the Alternative Medicine Index from the University of Maryland is it. Now, keep in mind, when you do a search for something you’re going to come up with multiple documents, and some of them are going to conflict, but nevertheless, it’s the best place I’ve found to look up the real information on alternative / supplement / herbal treatments.

3. What I Could Have Told You – St. John’s Wort Doesn’t Work for Depression

OK, technically St. John’s Wort doesn’t work better than a placebo in mild depression and earlier it was shown St. John’s Wort doesn’t work better than a placebo in moderately severe depression either. (There could be reasons for this, such as formulation and strength, but it’s what we know for now.)

Important – Please read the warning about using St. John’s Wort

(FYI, the studies were undertaken by the National Institute on Mental Health, a widely-regarded agency with (in my opinion) no conflict of interest here.) (Curious about mine?)

Until next week when I will learn more and try to do better.

* As always, the Psychiatric Times articles require a membership – but it’s free.

Are Psych Meds Addictive? – Antipsychotics (Part 2)

→ June 28, 2011 - 14 Comments

Are Psych Meds Addictive? – Antipsychotics (Part 2)

In the first of this series I discussed antidepressants and addiction. Some people contend antidepressants are addictive; however, not only is the term “addiction” not defined medically, the use of antidepressants does not generally match the symptoms of any defined substance use disorder either. (More information on substance abuse and substance dependence.)

This time antipsychotics are up to bat. Are antipsychotics addictive? Are people dependent on antipsychotics? Do antipsychotics cause withdrawal?

Read more

What you should be Reading in Mental Health

→ June 3, 2011 - Comments off

Articles to Read on Bipolar and SchizophreniaBusy. Crazy. Crazy busy. New antipsychotic. You know how it is.

Mental Illness Articles You Should Read

As per the usual, however, I plow through my own research materials like a crazy person possessed. So I do know of many excellent articles you should be reading.

Check out these articles from Breaking Bipolar and other great sources:

Hope you enjoy, I’ll be back with fresh content next week.

Depressed People Who Take Antidepressants Do Better Long-Term – Part 2

→ May 16, 2011 - 5 Comments

As I mentioned last week, it’s very difficult to measure long-term outcomes of depression treatment due to the confounding depression variables like severity of depression, duration of depression, number of depressions and so on.

In short, the sicker you are, the more depressed you are, the more likely it is you’ll get treatment.

Antidepressant Treatment Outcomes Long-Term, A Study

I discussed the basic outcomes of this study: The association between antidepressant use and depression eight years later: A national cohort study by Colman et al. (you may have to select Science Direct to see the study, you don’t need a subscription) which tries to take these variables into account.

Colman et al. showed those who took antidepressants had better depression treatment outcomes than those who didn’t, eight years later, once confounding variables were taken into consideration.

I’ll now point out the strengths and weaknesses of this study as well as some other interesting tidbits shown or cited in the study. Oh, and I’ll give my opinion on what it all means.

Strengths of this Depression Treatment Outcome Study

No study, of course is perfect, but each has its strengths. In the case of this study on depression treatment outcomes, some of the strengths include:

  • An attempt to quantify and account for factors we know will affect treatment outcomes
  • Study uses a large, heterogeneous, real-life, population base
  • Quality, fairly comprehensive data available
  • Replicated findings of a British study involving anxiolytics (anti-anxiety medication) and antidepressants

Weaknesses of this Depression Treatment Outcomes Study

Weaknesses mostly bias the outcome towards the conservative. In other words, the relationship between antidepressant use and a positive long-term outcome may be stronger than reported.

  • Does not have 100% data over eight years (Those who dropped out had worse depressions. This biases the data likely indicating a stronger relationship than shown.)
  • Not a randomized controlled trial (not likely possible)
  • Does not capture comorbid (co-occurring) disorders (likely indicating a stronger relationship than shown)
  • Does not specifically capturing other treatments*
  • Didn’t control for perception of need for treatment. In other words, those who were able to identify the need for, and seek, treatment took antidepressants and had better outcomes. So a factor then would be the person’s treatment-seeking behavior.

For all the nitty gritty on the strengths and weaknesses of this depression treatment outcome study, see here.

Outcomes of Antidepressant Treatment of Depression, Facts

In addition to their main findings, here are some other interesting depression treatment outcome facts either shown or referenced in the study:

  • Antidepressants are particularly useful for those with severe symptoms
  • Of 285 depressed patients, those using higher levels of antidepressants were significantly more likely to recover from symptoms in the short term (from a 20-year study)
  • British study found that of 204 depressed patients, those using antidepressants or anxiolytics (anti-anxiety medication) were significantly less likely to be suffering from symptoms of depression ten years later
  • Maintenance use of antidepressants has been shown to reduce future depressions
  • Those with partial remission (still having some depression symptoms) are far more likely to experience future depressions
  • The longer depressive symptoms persist before treatment the worse the long-term prognosis
  • The most strongly correlated value to better outcome was recent antidepressant use

Depression Long-Term TreatmentFunding of Depression Treatment Outcome Study

Because I knew you’d want to know (I did too):

Funding for this longitudinal depression treatment outcome study was provided by government, grant and award money. Study was cleared through the Health Research Ethics Board of the University of Alberta.

So Long-Term Antidepressant Use is Good?

Well, I can’t say that. What I can say is this study is suggestive^ of the fact that people who are depressed and take antidepressants do better over the long-term than those who don’t. But remember:

  1. People weren’t necessarily on antidepressants the whole eight years.
  2. The key (shown in studies and in my opinion) is to treat the depression as soon as possible and get all symptoms into remission.

So, that doesn’t mean get and stay on antidepressants forever, nor does it mean go on and off antidepressants. Those are individual choices depending on the person’s situation. If you can achieve #2 then your prognosis (in my opinion) is very good. And generally this is done with antidepressants, but depending on your personal situation, you may be able to achieve it through other means.

This also shows people taking antidepressants don’t do worse. This matters because there is a meme out there that taking antidepressants will somehow eat your brain and create mental illness.** This study suggests not.

A Little Bit More

* Study also talks about the role of therapy in depression treatment but no relationship was found between those who got therapy and those that had more positive outcome, suggesting there was no benefit to therapy. However, this is likely due to the broad definition of the word “therapy.” This is why I chose to omit information therapy findings.

^ This is not a causational relationship (where we know one thing causes another) as causation is hard to ascertain without real double-blind placebo controlled randomized study. And we don’t have that.

** Antidepressants actually increase the creation of neurons (neurogenesis) and increase brain volume.

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