Category: depression

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

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.

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The Daily Athenaeum Response Regarding the Depression Article

Last night I received a response from John Terry, the managing editor at The Daily Athenaeum. While I am rather disappointed to its content as it seems to have missed my points, I do appreciate someone from the paper taking the time to answer my email.

Objection to the Depression Article and Abusive Comments

Depression Article Response

One of the points John makes is that they cut off comments because the comments became “abusive, attacking.” While I don’t agree, the comments seem pretty tame to me, I will say that I do agree with his point that it isn’t acceptable to abuse or attack the author of the article or other commenters. In my opinion, the issue with The Daily Athenaeum’s piece has more to do with editorial permission to publish and less to do with the individual author. Any one person can be ignorant and uninformed but that’s when it’s up to the editor to step up and make sure that such content does not get published.

Moreover, my objection is around the content and the effect it has on others. This takes precedence over even editoral judgement. That multiple people that such stigmatizing and minimizing remarks were acceptable to print at all is the problem, not the individuals, per se.

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Letters to the West Virginia University Regarding Depression Article Feedback

The following is a copy of the two letters I have sent to the West Virginia University (see why I’m fighting their stigma here). I have yet to receive a reply. You are welcome to copy and paste any parts that you like and send them yourself. The most voices the better.

Send Your Email to the Newspaper and Other University Staff

I sent this letter to everyone at the paper as well as psychology and journalism heads at the school:

To: ‘DAnewsroom@mail.wvu.edu’; ‘DAPerspectives@mail.wvu.edu’; ‘Alan.Waters@mail.wvu.edu’; ‘Tracy.Morris@mail.wvu.edu’; ‘Kevin.Larkin@mail.wvu.edu’; ‘William.Fremouw@mail.wvu.edu’; ‘Maryanne.Reed@mail.wvu.edu’; ‘Diana.Martinelli@mail.wvu.edu’; ‘CHERUKURI@huffingtonpost.com’; ‘Danielle.Faipler@mail.wvu.edu’

CC: ‘velasconyc@yahoo.com’; ‘DASports@mail.wvu.edu’; ‘DAA&E@mail.wvu.edu’; ‘Erin.Fitzwilliams@mail.wvu.edu’; ‘John.Terry@mail.wvu.edu’; ‘Alex.Koscevic@mail.wvu.edu’; ‘Mackenzie.Mays@mail.wvu.edu’; ‘Lydia.Nuzum@mail.wvu.edu’; ‘James.Carvelli@mail.wvu.edu’; ‘Ben.Gaughan@mail.wvu.edu’; ‘Berry@mail.wvu.edu’; ‘Jeremiah.Yates@mail.wvu.edu’; ‘Jakob.Potts@mail.wvu.edu’; ‘Charles.Young@mail.wvu.edu’; ‘DACalendar@mail.wvu.edu’; ‘Matthew.Sunday@mail.wvu.edu’; ‘DA-Editor@mail.wvu.edu’; ‘BoFisher@mail.wvu.edu’; ‘Kyle.Hess@mail.wvu.edu’; ‘Alan.Waters@mail.wvu.edu’; ‘Pam.Dodson@mail.wvu.edu’; ‘chris.mcelroy@mail.wvu.edu’; ‘Jami.Christopher@mail.wvu.edu’; ‘roy.batesr@mail.wvu.edu’; ‘danewsroom@mail.wvu.edu’

To the Editors and Management of the Daily Athenaeum as well as the psychology and journalism professionals at West Virginia University,

After a lack of response regarding my prior feedback on the Depression can be treated through lifestyle changes article, I’m forced to again express my extreme disappointment in the handling of this situation.

I would like to encourage the editorial team to take this as an opportunity not only to acknowledge the questionable reporting, but also to help remove stigma from the mental health community. I strongly ask for:

  1. A retraction and correction of the published piece posted online, on Facebook and Twitte
  2. A series of education-focused articles on the mental health services available for WVU students and mental illness stigma
  3. A guest column on mental illness to be published (I would be happy to contribute this)

I am asking for professional journalism behavior as are the hundreds of other people who have read my articles on this subject. I look forward to your reply.

Natasha Tracy

Mental Health Advocate and Writer

https://natashatracy.com

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Coffee Good for Depression. Sybil Revealed. Bipolar Questions Answered. – 3 New Things

Keep up with mental health news. Three new things in mental health to learn this week:

  • The more coffee (caffeine) your drink, the less likely you’ll be depressed
  • Clinical records of real-life Sybil (part of the basis of “multiple personality disorder”) show likely falsehoods and unethical treatment
  • Get your bipolar questions answered by a clinical psychologist

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Mixed Moods in Bipolar Disorder and Depression in the DSM-V

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the manual that defines all mental illness in the US, is being revised and a new version is due out in 2013. One of the proposed changes to the DSM is to the diagnosis of mixed moods. This change is being proposed by a mood disorders workgroup. It aims to reflect clinical practice where doctors already refer to a “mixed” mood that doesn’t officially meet the DSM criteria. (As I noted, mixed moods are only technically recognized in bipolar type 1.)

Changes to the mixed mood diagnosis will help people with bipolar 1, bipolar 2 and unipolar depression get better treatment.

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

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. 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.

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