Antidepressants will work - just get the diagnosis right

4340418819 1a4fbc20cf m1 Antidepressants Do Work Gossip Doesnt

Clint: By Miguel Chajtur via Flickr

A Recent Article in the NY Times Discusses the Problems with Antidepressants

Dr Peter Kramer at Brown University wrote an article in the past Sunday NY Times Opinion Review: In Defense of Antidepressants - It’s a worthy read on several levels, not the least of which is the fact that it puts into perspective much of the outright gossip and diatribe about psych meds – specifically antidepressants. Bottom line: antidepressants do work predictably and exceedingly well – unless there are other comorbid issues, as we have so frequently documented here at CorePsych Blog.

Do take a moment to review Kramer’s antidepressant comments and my response comment in the NYT here below.

Said Kramer:

Last month brought an especially high-profile debunking [of antidepressants]. In an essay in The New York Review of Books, Marcia Angell, former editor in chief of The New England Journal of Medicine, favorably entertained the premise that “psychoactive drugs are useless.” Earlier, a USA Today piece about a study done by the psychologist Robert DeRubeis had the headline, “Antidepressant lift may be all in your head,” and shortly after, a Newsweek cover piece discussed research by the psychologist Irving Kirsch arguing that the drugs were no more effective than a placebo.

The Study Efficacy Numbers Just Don’t Match Office Experience

- Yet the unwritten, unhappy circumstance that distorts the efficacy numbers: Depression, like ADHD, often presents as far more than simply “depression,” with many comorbid and contributory problems that are often completely overlooked, as many myopically treat only the depressive symptoms that appear on the obvious surface. Untreated comorbid conditions do perpetuate the depressive symptoms – and frequently skew efficacy stats as well as clinical outcomes.

My Comment, #276, on Kramer’s Excellent NYT Article:

[If you think this comment makes sense please do weigh in and recommend it over at the NY Times.]

Thanks Dr Kramer for your courageous comments on depression and antidepressants, a conundrum of circumstances which, at this level of our neuroscientific development, should be taken for granted as positive intervention strategies, rather than so obviously controversial.

In 2011 we find ourselves still awash in wondering what-to-do because many aren’t yet listening to the available brain and body technology – the massive evidence available on brain and body neurophysiological imbalances. What we see is what we’re getting.

The unfortunate reality: depression itself, as most of the DSM4, is predominantly a descriptive term with little appreciation for, or measurement of, the underlying biology that can encourage depressive regression. For years we have considered these unhappy matters as only “conflictual” and “psychological,” rather than *also* originating as downstream effects of so many biomedical challenges. Nowhere is this more evident than in the fact that many professionals regularly miss cognitive depression because they only consider depressive ‘affect’ as the interloper. [Cognitive depression: Clint Eastwood as the Stranger in "High Plains Drifter" - he needs medication.]

The reason for the controversy is quite simple: we regularly miss the causal biology because we are not yet accepting biomedical evidence as replicable and useful. We overlook important medical questions, food allergy questions, immune dysregulation questions [and more], as we tilt with the tips of icebergs rather than study those ominous underwater structures.

An interesting clinical example in this regard is the high controversy attending biomedical measures such as SPECT imaging, measurement of urinary neurotransmitters, and testing for IgG imbalances – all of which yield measurable targets. Many accept cholesterol as a biomarker – but cholesterol is not “diagnostic,” as even high levels can be associated with clean arteries. Available science provides more answers.

Or you can drop a comment here as well! Thanks,

Postscript

FYI: An additional Sunday Antidepressant review in Letters was pub at NYT [http://nyti.ms/nAsNWc]: Remember this perspective: Angell is a pathologist [bio says lecturer in 'social medicine at Harvard'], the other “experts” are psychologists, and yet it seems that they continue to quote numbers, with no earthly psychopharmacologic experience. Personally, I have no clinical experience to comment on pathology or the vagaries of psychological testing. So often we see trauma surgeons commenting on psychiatry… it’s like baseball players who become experts on child care. The big problem with psych: everyone thinks they’re an expert – from ADHD to antidepressants.

Looking at numbers cut from research based upon appearances with no biologic understanding and a clinical bias against medications in the first place only encourages the more informed to dig deeper and explore the variables that actually create that measurable unpredictability.

We Must Improve The How, Not The What

Psychiatry is common sense, – isn’t it – or is it? Let’s just take a moment to get all of the variables straight – is the problem the meds or the way we use the meds?

The plain truth: Yes, meds are indeed often used ineffectively and capriciously, but ineffective outcomes are most often not the fault of the meds, rather the misinformation and limited knowledge of how to use psych meds by practitioners in general. Used carefully, with understanding CYP 450 and metabolic vagaries that arise more often than not, antidepressant meds work quite predictably.

Let’s not throw the baby out with the bathwater. Irresponsibly biased anti-medication reports can actually kill people.