Health Education: depression

Depression, Pills and Trying Something New

"If one medicine doesn't work, why take another?"  She asks rather simply.  Maybe it isn't the pill that's the problem but treating the illness WITH pills.    I am NOT a physician.  Still, every time I hear the latest commercial for the antidepressant medicine Abilify - I get sort of freaked out.  The side effects are intense and listening to them makes me well... depressed!  Uncontrollable movements, high blood sugar, coma, death....    I cannot  (and do not) suggest that anyone taking a medicine stop doing so.   But I would consider whether a different strategy - LIKE EXERCISE - is worth trying, or adding.    Instead of asking your doctor or psychiatrist if "abilify is right for you" maybe ask if you could do something BESIDES take more pills.  It could well be that "exercise is right for you."    It's just a thought... well, it is more than a thought because there is scientific evidence that exercise reduces depression in some people.  There is no money in it - you don't have to go to the doctor to get an order for it, or pay the pharmacist to pick it up - but you sure have to own it. It doesn't work if you don't do it.  And like the medicine you take - its generally needed at LEAST once a day.

Depression, Pills and Trying Something New

"If one medicine doesn't work, why take another?" She asks rather simply. M aybe it isn't the pill that's the pr...

6:59 PM

ECT - Shock Therapy - Proof of Safety?

Electroconvulsive Therapy or ECT or Shock Treatment has been used to treat mental illness at least since the 1940s though the concept of shocking the brain or body to treat maladies is much much older.  Instead of going the way of bleeding and leeching; however, ECT has been revised.  It is now conducted under more human conditions. Longtime readers would recall that when I started my weekly newsletters, I was a psychiatric social worker and in fact, worked with people who received ECT.  I did not blog about it of course.  I supported the treatment decisions of patients and their families and I respected the psychiatrists and psychologists with whom I worked.  At the same time - after witnessing the treatment itself (in an hospital room, with anesthesia, muscle relaxants and the monitoring of vitals - electrodes are attached to the head - shock can be unilateral or bilateral and lasts a minute at most) and seeing the affects on mood (it usually worked) and memory (it sometimes impaired it) I went home and made sure that my living will excluded the use of ECT.  I think I may have written that I had to be on the verge of death with no chance of recovery before it could be considered. ECT is primarily meant for the treatment of severe, resistant and recurring depression.  Some persons who suffer a nihilistic type of depression will think that they are already dead or will die.  They lose touch with reality, are unable to function, and stop eating.  I have written letters to support emergency ECT in such cases noting that without the treatment the patient might require feeding tubes and such to sustain life. But I do not like ECT.  And I am not comfortable with studies that compare ECT with antidepressants and with nothing and then say it is better.  I was not an emerging scientist when I worked at the hospital - but I am now and the research is flawed.  Where is the study that compares it with exercise, for example?  Another concern is that ECT as a medical device/treatment was approved under the 1976 FDA legislation that allowed current drugs to stay on the market temporarily.  The new FDA would henceforth require standardized, rigorous clinically controlled trials before deciding on whether to grant approval to any drug or device maker to unleash its product on the people of the USA.  The PMA status or premarket approval - was meant to be a temporary stay - the companies were supposed to submit the safety and efficacy data for after market approval - no one did. The gig is up.  The FDA has requested this information and a hearing is to be held this month.  Here are links to some FDA documents pertaining to the issue.  <a href="http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/510kClearances/ucm133989.htm#3">This one</a> lists several devices that are being asked to provide information. If you scroll down, you will see what that information must contain. The agenda for the ECT meeting is as follows: On January 27 and 28, 2011, the committee will discuss and make recommendations regarding the possible reclassification of devices indicated for use in electroconvulsive therapy. And this is the link to <a href="http://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/pmaapprovals/default.htm">PMA policy</a>. If you or a loved one has had ECT and found it to be helpful then it WAS helpful.  If you are concerned about the treatment for yourself or another, check out the <a href="http://www.fda.gov/AdvisoryCommittees/Calendar/ucm234979.htm">announcement</a> again.  There are means by which the public can comment and of course, follow up to see what information was provided to the FDA on the safety and efficacy and review the subsequent panel recommendations.

ECT - Shock Therapy - Proof of Safety?

Electroconvulsive Therapy or ECT or Shock Treatment has been used to treat mental illness at least since the 1940s though the concept of sho...

5:53 PM

Depression

I am not exactly going to blog about depression. In a bit of irony however, a research study was published in JAMA regarding the effectiveness of a few psychotropic medications I mentioned in my blog about anxiety yesterday. With the Penn State study and a previous study from the University of Hull (UK), comes more evidence that these drugs, at least in the treatment of depression, are not a panacea and may not even be a temporary fix. Several schools and several researchers were involved in both studies. They evaluated existing clinical trials, some which weren't published but made available through the freedom of information act, and they LOOKED BEYOND THE HEADLINES... In some cases of severe depression, which was not defined, but from my experience would include persons with nihilistic delusions, severe apathy, extreme weight loss or gain and inability to function - there was some effect, with some of the drugs, some of the time. BTW, electroconvulsive therapy also works! Instead, most studies show that there was no difference between the drug and a placebo. With the great risk associated with these drugs, mostly weight gain and then diabetes, that should be a treatment changing finding. This is the type of research we need. Billions of dollars are spent on these drugs - Paxil, Prozac, Zoloft, Effexor and more. One drug company that responded to the study said that the design of their studies and the university studies were not the same so they really weren't going to comment beyond noting that their medications had improved the quality of life for many people who take them. Drug companies say that they are not creating the drugs for people with mild to moderate depression, but you sure wouldn't think that from watching their ads. If anything, they seem driven to convince us all that we have clinical depression and their pill could eradicate it in a day. Truth be told, even when drugs are deemed effective, it is after several weeks of taking them. Two things in the Forbes article by R. Langreth are worth repeating. One clinician advised that alternatives to medicine should be considered and that includes exercise and talk therapy - I am sure that some of the strategies for managing stress in yesterday's post would also be helpful. Another scientist noted that the idea that drugs that keep serotonin (a mood stabilizing neurotransmitter) available in the brain (uptake inhibitors) really were not effective and that the idea that a lack of serotonin leading to depression is a MYTH! I think they should concentrate on endorphins and dopamine which is probably why so many studies do show that exercise is at least as effective as drugs in treating this condition and a helluva lot safer. I will share a personal story with you now. It is something that happened to me at least a hundred years ago, or maybe ten... I was having a bad time and went for some counseling. This was after my first round of college but before my graduate work, etc. I saw the counselor a few times and then one day she said, "I spoke with your insurance company and they think the best thing to do, the thing that will work the fastest, is to put you on medication - an antidepressant." I cannot in words express to you how angry I became. I certainly used very bad language. I could not believe that I had come in to get a sense of direction, do a little brainstorming and goal planning and was told that I had clinical depression and needed pills. I told her that I would not take medicine, I was not depressed, but had issues with the way my life was going - or the path I was on. I was unhappy, yes, but I was going through a crisis. She did say, something like wow, that is the first real emotion you've shown since we started. WHATEVER! :) But you know, this was a turning point to me and what I said to her then is very important for all of us. I was going through a crisis. And contrary to what Big Pharma wants you to believe, life stresses and even significant crisis do NOT require medication and even if they did, the ones out there do NOT work. I am not talking clinical and severe depression and please, never abruptly (or without telling your doc) stop a medication that you have been prescribed, but also know that sometimes the only way out of something is through it - you have to take one step at a time and get through it. Exercise and writing or talking things out - that'll help.

Depression

I am not exactly going to blog about depression. In a bit of irony however, a research study was published in JAMA regarding the effectiven...

4:25 PM

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Depression, Pills and Trying Something New

ECT - Shock Therapy - Proof of Safety?

Depression

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