Treatment-resistant depression

[ellenrr]

"The sad fact is that treatment resistant depression is increasing, and there is a great deal of evidence that the reason for this increase is long-term use of antidepressants. A review of the research in 2011 in the journal Medical Hypotheses concluded: “Depressed patients who ultimately become treatment resistant frequently have had a positive initial response to antidepressants and invariably have received these agents for prolonged time periods at high doses.”



http://brucelevine.net/too-corrupt-too-insane-and-too-ridiculous-to-be-reformed-even-establishment-psychiatrists-now-distancing-themselves-from-their-own-profession/

[cbayer]

1. Wow, your link goes to another article, but it sure does tell you where this author

is coming from.

It's going to be hard to take his analysis seriously when he is so overtly hostile to psychiatry.

[ellenrr]

2. It's a point of view. No need to dismiss it, until you read the article. He is

hostile to psychiatry.
so am I.
But that doesn't mean that anything I say, or he says, is without merit.

I'm hostile bec. of what I know about it, not bec. I woke up one morning after a dream and decided to be hostile. I base what I think on facts.

Imo, it is helpful to read the argument and then decide,
on the basis of reason, and experience, rather than dismiss it out of hand.

If you do, I'll be interested to know your opinion.

[cbayer]

3. I would suggest you change the link to the article you reference.

I will be glad to take a look at it, but I'm not going to search for it.

I would particularly like to look at the data he is using, as I find the initial premise pretty unsupportable.

If your hostility is based on facts and data, I would be interested in discussing it with you as well.

I have serious criticisms of psychiatry, but am, in general, very supportive of it as a medical field and of the people that are cared for within it.

[cbayer]

4. Whoops, forgive me. I see now that you excepted this form the linked article

and it is not a separate article. Will take a look at the part you are referring to.

[ellenrr]

6. I also think that when an insider criticizes psychiatry,

as are some of the people quoted in the article, it carries weight.

[cbayer]

5. Ok, I read the part of the article you reference in your OP.

Ok, the initial statement that treatment resistant depression is increasing has no factual basis that I can find or that the author cites.

Secondly, the article he quotes and links to is a very superficial review of the literature that leads to a proposal that has no data to back it up at this time.

The author of this article is making definitive statements that have no basis in fact or data. He is clearly not a scientist.

The fact that it was published in a journal called "medical hypotheses" should be a giveaway.

Anyway, is it possible? Certainly. Should the hypothesis be pursued? Absolutely.

Is there any evidence to state it as fact. Absolutely not.

[HereSince1628]

7. IMO some basic misunderstanding of theoretical effort is in play

Scientific method'S' include surveillance, experimentation, and theoretical efforts. American education emphasizes experimentation, and if asked most Americans would likely explain -the- scientific method in terms of experimentation. For biology this follows from decisions that went into building the BSCS curriculum way back in the late 1950's.

Theoretical methods are a valuable and valid means of study, although like other types of study they can be poorly done and flawed. Published reports of empirical findings accumulate to fill library and server space. Theoretical methods are employed to summarize and construct more general explanations from the various sources of empirical experience. The goodness of theoretical explanations is largely dependent upon the capacity of the theoretical explanations to generate hypotheses particularly critical hypotheses that test the validity of the theoretical explanation. The journal Medical Hypotheses serves the need to communicate these ideas, it's name probably shouldn't be an indication that it is a sham journal. The quality of a scientific journal must be judged on what I'll simply call its meaningful contributions to the discipline it serves.

I'm not familiar with this journal and don't have access to bibliographic tools that would help me assess it. The publisher, Elsevier, produces many journals, my familiarity with the publisher is journals in ecology, the reputations of which are varied.

Al-Malahk et al communicate a hypothesis, a result that emerges from application of theoretical methods... postulating an explanation drawn from details of other studies. Their various suggestions include the notion that the anatomical and functional changes in developing Rattus brains exposed to antidepressants may also occur in humans, as well as the notion that a genetic variation that interferes with serotonin systems may provide a useful model of a neurological system that is unable to respond to SSRI's. The evaluation of those ideas obviously involves expert criticism of the logic and information included in construction of that explanation, as well as the results of studies.

Evaluation of these Al-Malahk et al hypotheses is NOT the purpose of Levine. Levine's purpose appears to be arguing against the use of anti-depressants, and he builds upon the notion that SSRI exposure changes in developing Rattus brains and the obvious implications if similar changes take place in human brains exposed to SSRIs.

IMO, there is still much uncertainty about the details of the role of serotonin in depression. The notion of "chemical imbalance' is too widely uncritically accepted by psychologists, and users. Depression undoubtedly involves biochemistry, anti-depressants are chemicals and obviously have some effects on depression in some/many users.

Even without being an expert it's fairly obvious that there is a risk of making an error in going backwards with that correlation to arrive at the widely uncritically accepted notion that a nebulous something referred to as 'chemical imbalance' is the cause of depression (and many other mental disorders).

That makes consumers very vulnerable to the notion that depression (and many other mental illnesses) can always be mitigated with a proper elixir. It may also push consumers away from useful therapies of professionals who don't supply chemical fixes. In short, this generates many potential conflicts of interest surrounding psychopharmaceutical treatment of depression. IMO, the Levine essay seems to be addressing that.

Yet, all metabolic activity is chemical activity; as attractive as it is, the invocation of chemical imbalance really says very little. Depression may be a single outcome (equiterminus) that variously results from one or multiple effectors on neurological processes, or there may be multiple types of subtle yet different depressions which appear much the same behaviorally but have different causations. How one views that depends largely upon variations in expertise and motivation.

From a practical experience point of view, the trial and error nature of therapy for depression is quite suggestive of the existence of lack of understanding to a degree that impacts therapy.

[cbayer]

8. Than you for this.

I actually did read it and found it very digestible.

I may have reacted strongly based on my review of the author of this piece. He appears to be a zealot and I can find very little reasonable about him. Even when he links to this review of treatment resistant depression, he gets it from a site called "toxic psychiatry".

Even when considering theoretical methods, the degree of bias on the part of the person posting this article makes me very suspicious of anything he might advocate. He is clearly no kind of scientist, whatever approach you wish to take.

I agree that there is a lack of understanding that impacts therapy. Although the advances have been great, the understanding remains rudimentary. That is not only true for depression but all of the major psychiatric illnesses.

Those on the front lines are doing what they can with what they have. It's a desperate situation with a limited number of tools.

I put this guy in the same category as Szasz and condemn his hostility towards those who are working hard to help others.

[HereSince1628]

9. Yes, the hypothetical paper is being taken as something it is not

And the blog author definitely is working from a position very critical of the use of psychopharmaceuticals. Persons with strong opinions often do become closed minded and biased in the way they interpret information.

Being open to critiques about chemical imbalance is probably important to collecting information to protect oneself against misuse/overuse of psychopharmaceuticals. But, being open to consider critiques doesn't at all require surrendering critical thinking about arguments made against the critique. Indeed, it's important to look at the strengths and weaknesses of that criticism... and thanks to you for commenting on several of them.

Here is something from a different source than Levine, although it's also not a professional science journal...Psychology Today

Let me share a yet to be published study by Dr. Brett Deacon and his colleagues. They recruited 91 adults who are clinically depressed or once was. To make this credible, he gave everyone a fake "Rapid Depression Test" that determined whether their serotonin levels were abnormally low compared to other neurotransmitters. To make this test seem legit, they swiped the inside of people's mouths with a cotton swab and the saliva was carefully moved to a sealed container to be taken to the lab for examination. Afterwards, everyone received detailed test results and a random half of participants were told that their serotonin levels were problematic and there is a clear chemical explanation for their depression. The other half were told their serotonin levels were normal and their depression cannot be purely explained by brain chemistry.

The big question: What happens to people when they buy in to a biomedical explanation for their depression?

The answer: Bad things. They become pessimistic that recovery is possible. They become less confident that they can manage and regulate negative moods that arise (and they always do). The notion that depression is their brain's fault does not lessen the stigma or self-blame one bit. And they no longer believe that psychotherapy is a credible or useful strategy for treating their depression and instead, are ready to be dispensed a pill cure. Essentially, they become less flexible in their options for treating depression and less confident that they will escape its clutches.

It is going to be tough to battle the science fiction promoted by pharmaceutical companies. What makes the challenge increasingly difficult is that these companies spent $57.5 billion to promote drugs in 2004, and the numbers are only getting bigger. If we care about reducing human suffering, it's time to bring on the noise and ensure that everyone knows the science. We are fortunate to have scientists that are willing to fight powerful companies and dominant beliefs in search for the truth.

http://www.psychologytoday.com/blog/curious/201403/what-causes-depression-myths-about-chemical-imbalances















I'm glad some people get benefits from atypical depressants