3 days ago
Thursday, June 2, 2011
The scientific literature for anxiety and depression continues to amuse, entertain, and on rare occasion actually enlighten. I'm not even sure why I read the journals, since for the most part my only comment is "no duh." But my psychologist continues to remind me that there is a difference between something being obvious to me as a sufferer of mental illnesses, and having actual metrics and research to back it up. At least we have more and better ways to explain how crappy we feel.
But I don't want to actually get too down on it. As a scientist I love research and data, I just wish these papers I read would say something really surprising. I wish they would offer a jolt of realization, a truly new idea or approach. Instead they say things like, "The people with GAD in this study felt bad, and the people with GAD as well as other diagnoses felt really bad." In spite of everything, I keep hoping to spot that magic formula, that golden key that will unlock the mess that is my mind and make everything come together.
One advantage of reading over and over things you could have told the researcher yourself is validation. There is now a lot of research backing up what many of us have been saying for years. It gives me more faith in myself and my perception of my own situation. And in spite of my belly-aching, the fact that I do keep reading the journals must mean I am enjoying it to some extent. It's hardly required reading.
Anyway, here is something that caught my eye in the April 2011 issue of Depression and Anxiety. (Yes, I'm behind in my reading.) Hollon wrote a report entitled "Cognitive and Behavior Therapy in the Treatment and Prevention of Depression." Here is an interesting quote about ADMs (Antidepressant Medication) "A recent reanalysis of the FDA database for all registered trials for a dozen of the more recently approved medications (including the bulk of the SSRIs) found evidence of substantial publication bias. Trials that produced positive findings almost invariably found their way into the literature, whereas trials that did not either were never published or were published in a manner that made the target medication appear to be efficacious when it was not."
This is sad, but not unexpected. Null results are always harder to publish, and large drug companies that fund many studies are not going to promote a paper that shows their drug is mediocre. The reason I honed in on this is because I am a strong advocate for multiple kinds of therapy being used together - an integrated, holistic approach to treating people as whole people. In my case, that means both meds and talk therapy, as well as other things. I've known too many people who chose to treat depression with meds, and nothing else. Hollon goes on to say, "Finally, there is no evidence that having taken ADM does anything to reduce risk for subsequent symptom return and standard practice has evolved over the last several decades to keep most patients who respond on medication indefinitely."
And, well, some of us may need that. I'm not sure I'll ever be in a position to go off the meds completely. I had four major depressive episodes that were completely untreated, and that carves quite a biochemical path through the brain. Still, I do not think this means everyone needs the meds forever, as is the current trend. I also think that concentrating on just meds means that a lot of people who need deeper intervention never get it. There are people who would improve and take control of their lives in a whole new way if they had the right combination of treatment. Some talk/cognitive/acceptance type therapies DO have evidence to show a reduced risk for subsequent symptom return. And that is certainly some data that shouldn't be ignored.
I think as patients we need to be sure we advocate for the treatments we need - what we know works for us as individuals and complete people - rather than what is the trend of the moment. Research is great stuff, but in the end, bias shows up in the literature the same as it does in any human endeavor.
The literature can point us all over the place. I advocate that the investment we need to make in ourselves is to treat ourselves as whole people, who need a host of things like good food, sleep, and social interaction. Our minds and bodies are working with the same chemistry, and are the same electrical system. We need all kinds of options, like meds, CBT, ERT, talk therapy, DBT, yoga, meditation, acupucture, and more, to create a therapy program that really moves us forward in our healing.
Your Hostess With Neuroses
Image credit/info: [F]oxymoron, The Chemistry of Inversion, Creative Commons via Flickr CC 2.0
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