Psychiatrist Says, “Depression not a Disease”

National Public Radio devoted its show Science Friday to a debate between a psychiatrist who maintains that depression is not a disease and one who thinks that depression is a medical illness.

The two principals were:

• Harvard trained Dr James Gordon who founded and directs The Center for Mind-Body Medicine in Washington. Dr Gordon is the author of a new book Unstuck which prescribes a holistic program to deal with depression
• and Dr Peter D. Kramer who teaches at psychiatry at Brown University and practices psychiatry in Rhode Island. Dr Kramer is the author of many books including Listening to Prozac and Against Depression. The latter argues that the term depression has many meanings in our culture but most important is the fact that depression is a medical illness.

What is Depression

To Gordon, depression is a signal that something in one’s life is out of balance and can be a beginning to transformational change where a person can become unstuck and move forward.

On the other hand, Kramer sees depression as a cluster of disease traits and symptoms:

• Level of pain;
• Runs in families;
• Disruptions in normal brain activity;
• Co-morbidity with other illnesses such as diabetes and heart disease;
• And tendency to be recurrent and progressive.

So depression looks, smells and acts like a disease to Kramer.

Causes of Depression

Dr Kramer pressed his point that a depressed person’s brain activity and anatomy is abnormal. The head of the Center for Mind-Body Medicine responded that everything in the human body has biological manifestations.

Dr. Gordon believes that the primary response to depression should be a integrated program which includes meditation, relaxation, nutrition and exercise and help for the patient see the world and himself differently. Dr Kramer doesn’t write off these techniques but stresses that depression interferes with the ability to function which impacts careers and relationships and is dangerously associated with strokes, suicide and heart disease.

Depression and Medication

Gordon pointed out that recent antidepressant studies have shown them to be less effective that previously reported. The reason for this, according to Kramer is that the standards of research study have been raised:

• Studies now are based on larger samples of people;
• People are screened more rigorously before they come into to a study;
• And a closer review is conducted on the people who seemed to improve on the drug.

Dr. Kramer also mentioned that the studies of the effectiveness of psychotherapy has shown lesser results recently because the test bar in research studies has been set higher.

Dr Gordon maintains that usually stress is the primary cause of depression and the patient should first be guided through a multidisciplinary program; and that medication is the treatment of last resort for the very small percentage of people don’t respond to holistic treatment.

Morality and Spirit

During one exchange as Dr Gordon was making the point that a person needed to be guided through his program so that the patient could learn to help himself. Dr Kramer reacted by saying that the use of the word “guide” had a moral and spiritual feel to it that made him uncomfortable. Gordon responded by saying that doctors do help to save souls and they have a moral duty to do so. Kramer acknowledged that religion or spirituality can be very important to the patient.

A lot of what Dr Gordon had to say makes sense. In an ideal world, I would agree with his approach. Medications should be the last resort and not the first.

The profession of psychiatry is in a crisis. Efficacy claims for both psychotherapy and medications have been dropping based on new research studies. To be in the position of saying the reason the two treatments looked good a few years ago is due to bad research practices is devastating.

But there are elements of both our culture and the human equation that neither doctor brought up that explains what’s going on:

• Insurance companies have reduced psychiatrists to pill dispensers because it’s cheaper for a patient to spend 15 minutes talking with a doctor who then writes a prescription and sends them out the door. Of course the psychiatrist will prescribe a med, he’s a human being and wants to help is patient.
• Most people don’t have the time, interest or energy to participate in a multidisciplinary holistic program. Dr Gordon has stories in his book about people who have stretched themselves and been successful but they are very much the exception and not the rule. So the idea of taking a pill is probably the most attractive option for people.

Based on what I heard on Science Friday, I understand why we are in the mess that we are in. A healthy life style falls by the wayside when people don’t have the energy or time because they are figuratively running to stay in place economically; it’s difficult to change old habits; and there is big money to be made and time to be saved with drugs,

Antidepressants: No Diagnosis, No Problem

“Forty-three percent of those who had been prescribed antidepressants, had no psychiatric diagnosis or mental health care beyond the prescription of the drug.”

This comes from The Medicated Americans: Antidepressants Prescriptions on the Rise in the February issue of Scientific American.

The statement is mind-boggling. Most of these prescriptions are written by the family doctor for a drug that can have serious, even fatal side effects.

Reasons

I can see four reasons for this.

• Extensive advertising by pharmaceutical companies create such consumer demand that when many people visit their doctor they ask for an antidepressant and the doctor simply complies.
• The insurance companies steer people towards antidepressants because a pill is cheaper and simpler than paying for therapy or encouraging people to live a healthier life style.
• Many people are under tremendous stress.
• Old habits die hard; most people want a magic bullet. Take a pill, no fuss, no muss.

Results

People are taking antidepressants with no valid medical; others are not getting the thorough medical care they need. This results in some people:

• Becoming even more ill because they are receiving only partial treatment;
• Running to their family physician to take a pill for no medical reason instead of dealing with the root cause of a problem or making simple lifestyle changes.

It also results in a huge waste of money.

The pharmaceutical and insurance companies get richer, lots of money is wasted and people get sicker.

Bristol Myers Squib Gets 5YR Probation For Illegal Drug Sales

Bristol Myers Squib Chairman & CEO James M. Cornelius

His company (BMS) just paid out one of the biggest settlements ever for drug dealing. It sold the antipsychotic drug Abilify without FDA approval to children and the elderly. There were the usual consulting fees and luxury resort trips paid to doctors and health care providers to grease the skids.

In order to push product to little ones, BMS had a sales force visit “child psychiatrists and pediatric specialists”. For the elderly who had dementia, this pharmaceutical multinational created a “special long-term care sales force”

The icing on the cake was when the company tried to spin the fact they got 5 years probation with Inspector General’s Office by calling it a “corporate integrity agreement.” Where are mandatory jail sentences when you really need them.

Street dealers are more authentic than these guys.

Facts Courtesy of the Boston Globe

See also Harvard Psychiatrists Flunk Appearance of Propriety about peddling antidepressants to children.

Heart and Antibiotic Meds Treat Anxiety

Great NYT article today, Extinguishing Fear at the Roots of Anxiety.

Researchers are experimenting with a heart medication and an antibiotic to dull the unconscious darwain reactions associated fearful memories.

The heart medication blocks receptors linked to stress. This seems logical. They didn’t talk about the theory on why the antibiotic works. It’s a curious thing. I don’t have even have a clue as to how it might work.

For me anixety and depression are entertwined. When I am in depressive rumination all these hurtful memories come flashing back. The article made me realize there is a flight or fight response associated with these depressive memories.

Here is an article from DigitalFairfax, an Austrialian news organization, describing its research with the antibiotic and anxiety. You can read more about innovative treatments for OCD at WellnessOverDepression post OCD Patients Rewire Their Brains

All of this information shows great promise for the treatment of anxiety.

“Pharmaceutical companies end up marketing mental illnesses, not just pills.”

So says British Psychiatrist Dr David Healy in a NYT article about the difference in the rate of antidepressant prescriptions between England and the United States. There appears to be a rush in America and a go slow approach in Britain.

An American child is 5 times more likely to be prescribed an antidepressant.

Regulators in Britain are more conservative when approving drugs for market. And there is a lot of pressure in the U.S. to keep health care costs down.

Antidepressants are the insurance industry’s sole treatment of choice because it keeps costs down, even though it’s been proven that a combination of talk therapy and medication is the most effective treatment.

I don’t know whether pharmaceutical companies are allowed to market drugs for mental illness in Britain the same way it’s done in the States. Television ads of people turning from sad to happy after a pitch for whatever pill.

There is a strong correlation between the introduction of SSRI antidepressants and number of people diagnosed with depression.

One study presents hard evidence that large numbers of people labeled as bipolar don’t have the disease.

In a recent NPR interview a researcher, Mark Zimmerman of Brown University and Rhode Island Hospital found that when he screened patients who came in and said that they were diagnosed bipolar, he could not confirm the diagnosis. People were under diagnosed six years ago now the trend seems to be the reverse.

There is speculation in the NPR segment that it’s the relationship between the pharmaceutical companies and doctors along with the difference in screening procedures between a clinical trial and the doctors’ office that accounts for people being misdiagnosed.

Much of the education that doctors receive about meds comes from the drug companies who are naturally interested in pushing their solution.

The diagnosis of bipolar disorder is very complex.

Research studies use a long structured questionnaire to determine whether or not a person is bipolar. In the everyday world that you and I live in, screening at the doctor’s office is likely to be based on a few anecdotes and some general discussion.

The cultural pressure in the U.S., economic and social, to prescribe antidepressants is very real. After all the drug companies have to make money and the doctors have to treat tons of patients. The next question is are we succumbing to the pressure.

Bipolar/Schizophrenia Advocacy Groups Gone “MAD”

This is a fascinating NYT article called MAD. It describes the efforts of different bipolar/schizophrenia advocacy groups to create social change.

I have problems with the style and rhetoric of some but support most of their goals. The organization I have the mixed feelings about MindFreedom International and their stand on drugs. I am for anything that keeps the drug companies on their toes. They should be challenged. The risk is that the advocacy group may dissuade people who really need psychotropic drugs from taking them. It’s up to the individual which is the way it should be in most cases.

The Stanley Medical Research Institute advocates forced medication for the most seriously ill who have great potential to hurt themselves or somebody else. I believe this foundation was created by a man whose son killed someone in NYC by pushing them in front of a train.

Although their tag line “Navigating the Space Between Brillance and Madness” makes me cringe, the Icarus Project is doing great things by educating the public and helping their own.

The only thing that I have a major problem with is referring to mental illness as “extreme mental states” or “dangerous gifts”. It maybe tantalizing to use this rhetoric but it’s terribly misguided.

Mental illness is just that an illness. We are talking about physical and mental suffering. We’re not talking about some group that suffers because of their race, gender or sexual preference. Mental ill people face both; they suffer medically and face being stigmatized and discriminated against.

One other thing, I believe the article’s author is not quite correct when she said things like exercise and peer counseling were “strategies that are well outside the mainstream of psychiatrists and many patients.”

I would like to hear other opinions.

Antidepressants Give New Life

The brain of a person with depression is withered.

Studies have shown that parts of the brain’s anatomy involved in planning and emotion are smaller than normal. Some cells are “weakened, disorganized and disconnected.”*.

The more bouts of depression a person suffers the more the brain is compromised. The “black dog” is thought to be a progressive disease.

Now comes a Boston Sunday Globe article Life of the Mind How Prozac Sent Science in the Wrong Direction revealing that the most popular family of antidepressants in the world, Prozac and its kin, don’t work the way we thought they did.

Their ability to increase brain serotonin was thought to do the trick. However what Prozac and others actually do is allow our brain cells (neurons) to grow and get healthy. This is great news; but with a catch.

In the article, Eero Castren, a neuroscientist at the University of Helsinki draws a comparison to steroids and bodybuilding . “If you just sit on your couch, then steroids aren’t going to be very effective. Antidepressants are the same way: If you want the drug to work, you have to work for the drug.”

There are lots of things you can do. We’ll be covering the type of work you can do in future posts.

* from Dr Peter Kramer’s book Against Depression.