To Treat Depression, Just Give ‘Em What They Want

[bananas]

Sounds like an ideal solution, a real win-win, etc.
Unfortunately over-all remission rates will still be <50%.
From February:

http://thoughtbroadcast.com/2011/02/23/to-treat-depression-just-give-em-what-they-want/

To Treat Depression, Just Give ‘Em What They Want

<snip>

A paper in this month’s Psychotherapy and Psychosomatics by Mergl and colleagues shows that patient preference (that is, whether the patient prefers medications or psychotherapy) predicts how effective a treatment will be. In their study, patients who expressed a preference for medications at the beginning of treatment had a better response to Zoloft than to group therapy, while patients who preferred therapy showed the exact opposite response.

In an even larger study published in 2009 by James Kocsis and colleagues at Weill-Cornell in New York (comparing nefazodone, an antidepressant, with a cognitive therapy approach called CBASP), a similar result was obtained: patients with chronic major depression who entered the study expressing a preference for drug treatment had higher remission rates when receiving medication than when receiving psychotherapy, and vice versa.

The numbers were quite shocking:

Patients who preferred medication:
Treatment received Remission rate Avg. depression score (HAM-D) at end of study (high score = more depressed)
Meds 45.5% 11.6
Therapy 22.2% 21.0

Patients who preferred therapy:
Treatment received Remission rate Avg. depression score (HAM-D) at end of study
Meds 7.7% 18.3
Therapy 50.0% 12.1

(original HAM-D scores were approximately 26-27 for all patients, constituting major depression, and patients in this study had been depressed for over two years)



Thus, if a depressed patient wanted therapy but got medications instead, their chances of “remitting” (ie, having a fully therapeutic response to nefazodone) were less than 1 in 12. But if they did get therapy, those chances improved to 1 in 2. Interestingly, patients who preferred therapy and got combination treatment (meds and therapy) actually did worse than with therapy alone (remission rate was only 38.9%), leading the authors to conclude that “few patients who stated a preference for psychotherapy benefited much from the addition of medication.”

<snip>

But then again, isn’t depression supposed to be a hard-wired biological illness? Shouldn’t a medication have a more profound effect, regardless of whether the patient “wants” it or not?

Apparently not. The fact that people responded to the treatment they preferred means one of two things. There may be two different types of depression, one that’s biological and one that’s more behavioral or “exogenous,” and people just happen to choose the appropriate treatment for their type due to some predisposition or innate tendency (self-knowledge?). Alternatively, the “biological” basis of depression is not all it’s cracked up to be.

<snip>

[villager]

1. oh: I thought it meant "give them what they want" like jobs, love, security, etc.

But I guess we can't have society doing that! ;-)

[bananas]

5. Soundtrack for this thread: "Whatever You Want" by Alexandra Hope

edit to add: This is really good.

Free download from Artist Direct: http://www.artistdirect.com/artist/alexandra-hope/4502863

Free download requires free registration from Record Label: http://rcrdlbl.com/artists/Alexandra_Hope/track/Whatever_You_Want

Review and embedded video of a different song at IFC.com:

http://www.ifc.com/blogs/indie-ear/2009/10/video-premiere-alexandra-hope.php
Video Premiere: Alexandra Hope - The Mirror
By Brandon Kim on 10/21/2009

Oh bugger, have I got a treat for you. Chanteuse/guitarist Alexandra Hope sounds like PJ Harvey and Sonic Youth in a dream about Charlotte Gainsbourg. She's an American and plays guitar like one, but the way she puts on airs is decidedly French -- hot dark simplicity.

<snip>

[SixthSense]

2. medication is not medicine

We have substituted diagnosis and caring with writing prescriptions, this is not the practice of medicine, this is the practice of snake oil sales.

[Odin2005]

3. Bullshit.

[Zoeisright]

4. Don't understand the scientific method, do you?

What a stupid statement.

[SixthSense]

6. I understand that this kind of "health care" doesn't serve people well

and also that the model is heavily influenced by the need of pharma to make a ton of money

I have not taken any prescription medicines in over 20 years and surprise surprise I'm a lot healthier than my peers... wonder why that is?

[villager]

8. +1

n/t

[Codeine]

10. Bull-fucking-shit. Medications save lives. Medications save minds.

Only a person who has never experienced a mental illness or chemical imbalance could make such an ignorant and uninformed statement.

[Avalux]

7. We don't know how antidepressants work, or if they work at all.

Although we know what they're intended to do, we can't quite figure out exactly how they treat/cure depression; it's a unknown area. So there's a question as to whether they are effective on a biological level. Clinical trials can't determine a clear statistical significance.

SO - we may have a placebo effect going on here; which is what I've often thought through my years in clinical research. If people want to be treated; want the medication, it will work for them. If they are reluctant or opposed altogether, it won't work.

It is possible that our own minds can cure us of depression and medication isn't any more effective than a sugar pill.

[demigoddess]

9. there is a placebo effect but also might it not be that a person

has a deep down basic instinct about their own depression. I have personal problems but I feel they do not cause my depression, I can have a lovely life and be depressed as heck, it must be a brain chemical thing. As for whether they do anything, you do not want to know me off my medication.