Blogging about therapy

I haven't posted in a while because I realized that in writing about what is broken in the mental health system is tilting at windmills. I think it is important tat there are people who keep calling attention to what has happened to the field and who determines policy. But after a while it starts to seem terribly redundant. Look at this, run by Reuters Friday:

Placebo effect may influence depression treatment

MAY??!!! It absolutely does and studies showing this have been around for at least 10 years.

The article goes on:

It cannot be assumed that an antidepressant has lost its effectiveness if a patient relapses while continuing on the medication, because the medication may never have been effective in the first place, according to study findings reported in the Journal of Clinical Psychiatry.

In the study, the majority of relapses occurred in patients who had never been true responders, Dr. Mark Zimmerman, director of outpatient psychiatry at Rhode Island Hospital, told Reuters Health...

To investigate, Zimmerman collaborated with Dr. Tavi Thongy on a review of four studies involving 750 patients. These were continuation studies of new generation antidepressants.

Using two different methods of estimating relapse, the researchers found that the majority of relapses occurred because the patients were never true responders to the drugs.

This suggests, Zimmerman told Reuters Health, "that a message can be conveyed to patients who have repeatedly improved on medication and then lost its benefit that perhaps they are more capable than they think in bringing their own resources to bear to improve their depression."

SOURCE: Journal of Clinical Psychiatry, August 2007

NINE years ago, Kirsch and Sapirstein published Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication. Their analysis :

Our results are in agreement with those of other meta-analyses in revealing a substantial placebo effect in antidepressant medication and also a considerable benefit of medication over placebo. They also indicate that the placebo component of the response to medication is considerably greater than the pharmacological effect. However, there are two aspects of the data that have not been examined in other meta-analyses of antidepressant medication. These are (a) the exceptionally high correlation between the placebo response and the drug response and (b) the effect on depression of active drugs that are not antidepressants. Taken together, these two findings suggest the possibility that antidepressants might function as active placebos, in which the side-effects amplify the placebo effect by convincing patients of that they are receiving a potent drug.

In summary, the data reviewed in this meta-analysis lead to a confident estimate that the response to inert placebos is approximately 75% of the response to active antidepressant medication. Whether the remaining 25% of the drug response is a true pharmacologic effect or an enhanced placebo effect cannot yet be determined, because of the relatively small number of studies in which active and inactive placebos have been compared

You may have noticed that the article reported by Reuters did not get huge play in the media -- because it goes against the grain of the dominant paradigm.

Okay, so these things turn up again and again. Data piles up and still, nothing changes. So, it feels pretty futile to me to keep ranting about this, satisfying as it can be from time to time.

So, I have decided not to write more about this particular issue or about drug companies. There are others -- Furious Seasons and Clinical Psychology and Psychiatry to name two -- who do this better. I plan to keep my focus on the therapy process and things related to that. It will be more fun and reduce my frustration level a lot.


© Cheryl Fuller, 2018. All  rights reserved.