In a small clinical study published a few weeks ago, researchers didn’t find much difference between the three treatment groups of depressed subjects they studied — a group that received antidepressant medications, a group that received a specific type of not-commonly-practiced psychodynamic psychotherapy, and a group that received a sugar pill.

But there were some serious issues with this study from the onset, issues that call into question not only the generalizability of the results, but also their validity. It’s a shame that Reuters, who picked up on the study just yesterday, glossed over the methodology problems of the study, and instead just repeated the results as a shiny new established fact.

And easily lost in the discussion is the best result of them all — 16 weeks was all that was needed for most people in the study (who completed it) to find improvement in the symptoms of their depression, no matter what the treatment.

Let’s see what went wrong, and what the study actually tells us…

This guest article from YourTango was written by Dr. Deb Schwarz Hirschhorn.

What a difference a few years makes.

“New Cures for Depression” shouted the 1986 essay in New Woman magazine; “Dramatic Progress against Depression,” blared a New York Times Magazine piece in 1990. Its subtitle was revealing: “The success of new drugs is prompting debate on their overuse—and the value of talk therapy.” That story smugly said that the new wave of antidepressants, including the then two-year old Prozac, which took the country by storm, had “proved to be as effective as the older ones and often safer.” What’s more, the article went on to say that these amazing new drugs worked when old-fashioned talk therapy didn’t. Psychotherapy was relegated to the dustbin of history.

Fast-forward just a couple of years. Suddenly, the manufacturer of Prozac, Eli Lilly, was being sued by families of people who either committed suicide or tried to do so while taking the drug. In the next 15 years, lawsuits for other antidepressants piled up against other manufacturers for the same reason: Forest Pharmaceuticals, maker of Celexa; Lilly (again), maker of Cymbalta; Pfizer, maker of Zoloft; and GlaxoSmith Kline, maker of Paxil.

Today is National Depression Screening Day, so it’s time for your annual depression checkup. Are you depressed? Or are you skirting the threshold of depression, feeling low on energy and taking little pleasure out of life?

You don’t need to make an appointment or go see someone in person in order to find out the answer to these questions. Since 1995, Psych Central has offered an online interactive depression test that gives you an instant result. While nobody can diagnose a mental disorder online, it can give you a quick sense of whether it’s something to be concerned about and make an appointment with a mental health professional to examine further.

The quick depression test is just 8 questions and is an accurate screening measure for depression. It takes most people less than a minute to complete. The longer 18-question depression quiz is the oldest one online and is a more thorough screen for depressive symptoms. It’s a little more accurate, and most people complete it in under 3 minutes.

It is an honor for me to publish the following piece by Ronald Pies, M.D., professor of psychiatry at SUNY Upstate Medical University and Tufts University School of Medicine, because I find him to be one of the most fascinating psychiatrists in the Northern Hemisphere (I’m thinking the Southern is full of kooks).

He always comes up with an intriguing angle on psychotherapy, antidepressants, the psychology of wellness … you name it, and he — like me — loves the intersection of faith and medicine, as is evident in his book, “Becoming a Mensch.” So, here’s a curious piece about why the we might blame the Puritans for the anti-med movement in the US. Let me know your thoughts, because I know that you will have some after reading this piece. I should probably also tell you that he wrote the foreword to “The Pocket Therapist.” I was once yelled at by a reader for not disclosing that … whatever.

These are not good times for Prozac and its progeny. In the popular media, the use of antidepressants has been likened to swallowing “expensive Tic-Tacs”, while in professional journals, the effectiveness of these medications has been challenged, if not discounted. And even a casual Google search under the terms, “Antidepressants damage” turns up thousands of websites and articles claiming that these drugs cause brain damage, induce suicide, or lead to “addiction.” Yikes!

Antidepressants have long enjoyed a reputation as being a quick and “easy” treatment for all types of depression — from a mild feeling of being a little down, all the way up to severe, life-debilitating depression.

But like all medications, they have side effects and instances where they should not be prescribed. Hence their continued need for a prescription after seeing a doctor.

So what does it mean when primary care physicians are handing them out like candy?

It suggests that your family doctor doesn’t really understand how antidepressants work, or what they are approved to treat. In short, it suggests that antidepressant medications are being over-prescribed by well-meaning doctors who are simply not using very good judgment.

Dear Mrs. ——–

You have asked me about the cause of your mood disorder, and whether it is due to a “chemical imbalance”. The only honest answer I can give you is, “I don’t know”—but I’ll try to explain what psychiatrists do and don’t know about the causes of so-called mental illness, and why the term “chemical imbalance” is simplistic and a bit misleading.

By the way, I don’t like the term “mental disorder”, because it makes it seem as if there’s a huge distinction between the mind and the body—and most psychiatrists don’t see it that way. I wrote about this recently, and used the term “brain-mind” to describe the unity of mind and body.1 So, for lack of a better term, I’ll just refer to “psychiatric illnesses.”

Now, this notion of the “chemical imbalance” has been much in the news lately, and a lot of misinformation has been written about it—including by some doctors who ought to know better 2. In the article I referenced, I argued that “…the “chemical imbalance” notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.”1 Some readers felt I was trying to “re-write history”, and I can understand their reaction—but I stand by my statement.

The question of whether or not you should start taking antidepressants is complex and difficult to answer. But even fuzzier is the question of when or if you should stop. Last May, NPR ran a piece called Coming Off Antidepressants Can Be Tricky Business.

Joanne Silberner writes:

Several top psychiatrists say there’s just not enough data to say for sure when to try coming off an antidepressant. Drug companies generally test their new products for a few months or up to a year. They don’t spend much time looking into how to taper off their products. The dense informational inserts that come with prescription drugs have a lot of information on how to take the product, but no information on how to stop.

Seems to me the basic conflict between men and women, sexually, is that men are like firemen.  To men sex is an emergency, and no matter what we are doing we can be ready in two minutes.  Women, on the other hand, are like fire.  They are very exciting, but the conditions have to be exactly right for it to occur.”
~ Jerry Seinfeld

I just couldn’t decide if he was really sponge worthy.
~ Elaine, Fictional character on the TV show. Seinfeld

There seems to be rather compelling evidence that semen may be a natural antidepressant for women.  The intriguing feature about this finding is that it emerged from research with lesbians.

In the September issue of Scientific American an article (see source below) focused on the many virtues of semen.  No kidding.  It would seem an article like this would be a comic’s dream to find.  But even Jerry Seinfeld would have to give the facts a second look.

Perhaps we’ve seen the rise and fall of psychotherapy treatment. At least when it comes to depression, the most common mental disorder diagnosed today.

The numbers don’t lie, according to multiple nationally-representative surveys conducted over the past two decades.

At the start of the 1990s, psychotherapy was the treatment of choice for depression, with 71.1 percent of depressed people saying they had been treated with psychotherapy. By 1997, with the newer SSRI antidepressants firmly taking hold in prescribers’ toolboxes, that number had dropped to 60.2 percent.

When the latest research when conducted, they found 53.6 percent of depressed people surveyed in 1998 were in psychotherapy. When they looked again in 2007, that number had dropped to a new all-time low — to only 43.1 percent.

In two decades, psychotherapy went from being the primary treatment employed for depression, to becoming a minority treatment. What happened?

I’m still bothered by all the hype awhile back about antidepressants not working any better than sugar pills (otherwise known as placebo) because I know that the people who need treatment — possibly those that will go on to take their lives — read that story and decided there was no hope in medicine.

That’s why I like to publish insightful articles like the one I found in John Hopkin’s newsletter, “Hopkins Brain Wise.” They included an interview with Glenn Treisman, professor of psychiatry and internal medicine who is best known internationally for his care of HIV-infected patients who also suffer from a psychiatric illness.

Here’s the interview…

In her national bestseller “Potatoes Not Prozac,” Kathleen DesMaisons offers a seven-step dietary plan for sugar-sensitive people like me. I’ve tried to implement her suggestions into my diet because, as a recovering drunk and depressive, sugar can throw me into an emotional mess that gets downright ugly.

A diet rich in fiber and protein is crucial to my mental health — but for me, it’s Prozac AND potatoes.

Here’s what DesMaisons proposes:

You’ve been diagnosed with a mental disorder and have been in treatment now for years. You’ve done both psychotherapy and psychiatric medications, and now it’s time to try to live life drug-free. You’ve successfully ended your psychotherapy treatment, but now you’re looking for advice and information about how to end your psychiatric medications.

My first suggestion to you would be to talk to your doctor or psychiatrist. Nobody should go off of any medication without first getting their doctor’s consent and, hopefully, cooperation (or, if not their consent, at least their grudging acceptance that it’s your body and you can do with it what you want). Ideally, you’re seeing a psychiatrist for your psychiatric medications and not just your family doctor. If you are just seeing your family doctor, you may need a little more help than someone seeing a psychiatrist, because psychiatrists have much greater familiarity with helping people get off of the medications they previously prescribed to them. (In my experience, I’ve found many family doctors simply have little clue about the idiosyncrasies of discontinuing psychiatric medications, because of their unique tapering properties.)