Jung At Heart Archive September 2008

Science?

Dinah of Shrink Rap, left a comment on my previous post about the study on telephone therapy :

"I ranted about this on Shrink Rap

Hard for me to see it as 'science'"

So I hied myself over to her blog and read her rant, which indeed it was. First, she responds to it as merely a blog post, appearing as it did on the NY Times health blog. Perhaps she was unaware of other sources reporting on the study, including this release from Northwestern University, where the study was done. And she says:

It's a blog post, not a rigorous scientific article, but I'm going to start by saying I thought the post is irresponsible. That feels strong, and I'm an avid Well reader, but it's full of all these blanket statements, given as facts, with nothing that backs them up. There's a link to an abstract, and an email to request the full article, but I'm going to note that the abstract also gives very little information about the methods used and the conclusions reached. I didn't write for a copy of the full article (I will) -- maybe it was great science that warrants the conclusion that phone therapy for depression is as good as live therapy, but it's hard to get there from either the blog post or the abstract. Stay tuned: we'll use the full article for a future My Three Shrinks podcast.

Well, I took the time this morning to return to the Northwestern site and re-read the article there and I am reproducing it in its entirety here:

CHICAGO -- The problem with psychotherapy has long been that nearly half the patients quit going after a few sessions. Therapy can’t work if patients stop coming to the therapist’s office. 

But a new meta-analysis has found that when patients receive psychotherapy for depression over the phone, most of them continue with the therapy.

Researchers from Northwestern University's Feinberg School of Medicine have taken   the first "snapshot" of telephone-administered therapy studies around the country. Telephone therapy is becoming more widely used by health care providers and employee-assistance programs. 

The new study found that the average attrition rate in the telephone therapy was only 7.6 percent compared to nearly 50 percent in face-to-face therapy. The telephone therapy also was effective in reducing depressive symptoms with results that appear to be similar to face-to-face treatment. 

"The problem with face-to-face treatment has always been very few people who can benefit from it actually receive it because of emotional and structural barriers," said David Mohr, professor of preventive medicine at the Feinberg School and lead author of the study, published in the September issue of Clinical Psychology: Science and Practice. "The telephone is a tool that allows the therapists to reach out to patients, rather than requiring that patients reach out to therapists." 

Mohr said that of the patients who say they want psychotherapy, only 20 percent actually show up for a referral and half later drop out of treatment. 

"One of the symptoms of depression is people lose motivation," Mohr said.  "It's hard for them to do the things they are supposed to do.  Showing up for appointments is one of those things."  

Patients also may not have the transportation or time to travel back and forth to a therapist's office. It may be hard to squeeze an appointment into days already crammed with work, caring for kids or elderly parents or other family obligations.

Telephone therapy seems to transcend all these barriers. Mohr began using telephone-administered therapy because he was working with patients who had multiple sclerosis who could not get to a therapist's office.  

Mohr said what’s needed is a definitive study with a randomly selected population of patients that directly compares therapy delivered in the traditional face-to-face manner to therapy delivered over the phone. He has already launched such a study in subjects who receive their primary care from Northwestern's Medical Faculty Foundation. He expects to have results in two to three years.  

Mohr's study was supported by the National Institute of Mental Health


Yes, this is a press release, not the full article. No claim was made that it was. And it was the press release which was picked up and reported in a variety of places. But the Times blog did not include that final sentence which I made bold -- the research was supported by the NIMH. 

And when I go to the journal, Clinical Psychology: Science and Practice here is the abstract:

Increasingly, the telephone is being used to deliver psychotherapy for depression, in part as a means to reduce barriers to treatment. Twelve trials of telephone-administered psychotherapies, in which depressive symptoms were assessed, were included. There was a significant reduction in depressive symptoms for patients enrolled in telephone-administered psychotherapy as compared to control conditions (d = 0.26, 95% confidence interval [CI] = 0.14–0.39, p < .0001). There was also a significant reduction in depressive symptoms in analyses of pretreatment to posttreatment change (d = 0.81, 95% CI = 0.50–1.13, p < .0001). The mean attrition rate was 7.56% (95% CI = 4.23–10.90). These findings suggest that telephone-administered psychotherapy can produce significant reductions in depressive symptoms. Attrition rates were considerably lower than rates reported in face-to-face psychotherapy."

What one can discern about this study from the abstract suggests it was designed much like most of the studies of CBT. It is a meta-analysis of a number of studies  looking at symptom abatement as the measure of success -- and because the whole diagnostic enterprise is based on impression ad self-report, this is as good as used in any other study of therapy -- and looking at attrition rates. So they were looking at 2 variables -- effect on symptoms and attrition rates. And they found that telephone therapy performed well on both. Looks like any of hundreds of studies in psychology and psychiatry that I have seen.

Science does not guide mental health treatment. The DSM is not based on theory or research -- see this post for more on this. Many of those within the field want to believe that what we do is science. But we depend on a nosology based on consensus statements of committees, statements which describe symptoms. There is no "scientific" way to arrive at a diagnosis, no lab tests or x-rays or MRIs or anything measurable. We have questionnaires which rely on inference on the part of the examiner and self-report by the patient. Medications which perform only slightly, when at all, better than placebo are routinely prescribed in the unscientific belief that brain chemistry is the culprit in depression. How is that scientific? 

All of us in the field -- psychiatrists, psychologists, social workers and the rest -- practice what we believe. Those patients who share what we believe improve and report the treatment is successful. Those who do not go elsewhere.

People who find telephone sessions valuable find it valuable. Those who don't, don't. That is not science; that is anecdotal evidence. Which basically is all we have to measure outcome. All the questionnaires and similar measures to measure success of any form of treatment rely on patient self-report.

So, I suggest to Dinah, criticize this study because it goes against the grain of your beliefs, that's fair game. But science? In the face of the studies that are emerging about the efficacy of the most commonly prescribed psychotropics, it seems to me to be shaky ground indeed to base objection on "science".

Sep 24, 2008 12:51 PM

Sometimes not seeing is better

For a number of years now I have worked with a fair portion of my patients by telephone. At first when it was suggested to me as a way to continue my practice when I moved, I was skeptical but now, seven years later, I find that therapy by telephone not only works, in some cases it works better than face to face meetings. So I was not surprised to see this appear in yesterday's NY Times:

A new analysis of phone therapy research by Northwestern University shows that when patients receive psychotherapy for depression over the phone, more than 90 percent continue with it. The research showed that the average attrition rate in the telephone therapy was only 7.6 percent, compared to nearly 50 percent in face-to-face therapy. The researchers also found that telephone therapy was just as effective at reducing depressive symptoms as face-to-face treatment.

The therapeutic space which develops when the work is done by telephone differs from that when therapist and patient sit face to face, but it is therapeutic space nonetheless. When my patients call. I am sitting in my customary place, just as if they were sitting in front of me in my office. And I suggest that my patient similarly be in the same place each time. We then create the space between us -- the sound of our voices and the time creating a temenos between us. Therapy works because it is contained. There is confidntiality, there is a fee, and a set time. Our work together is contained in this virtual space, just as it would be were we both in my office.

Phone psychotherapy eliminates travel and waiting time, and allows more flexible scheduling. It makes psychotherapy available to patients who are unable to travel, including many of the physically disabled and those whose symptoms, depression or agoraphobia,  make them reluctant to leave home and for those whose work takes them away from home frequently. And in a time when gasoline costs are a significant part of household budgets, it saves the expense of driving. It also makes therapy readily available to people living in rural areas with few if any therapists available.

It's always nice when research confirms personal experience.

Sep 23, 2008 1:04 PM

Platypus*

Thanks to CP&P, I found a new blog this morning -- The MacGuffin, another psychologist/critic of the mental health debacle. And in his post today he offers this, which is the best statement of why mental illnesses are NOT diseases:

"Mental Illnesses are defined as mixtures of symptoms packaged into syndromes. These syndromes are consensus statements from committees writing the nosologies of psychiatric disorders for the DSM of the APA and the ICD. Thus, mental illnesses are not diseases.   (Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications   pg178)

Remember I have said this before -- these categories were arrived at by committee, not through research.


*It has been said that the platypus was designed by committee

 

Sep 23, 2008 10:07 AM

Mad, Not Bad

When I was writing my dissertation on Medea, I became interested in the problem she has posed for feminist classicists.  Here we have a character who murdered in service of Jason's quest and who then killed again in reaction to betrayal by him and to protect her children, killed them as well. I was interested in Medea herself. As I searched for a dissertation advisor, I ran into a wall with the feminist scholars on the faculty of my university. As soon as I explained that I wanted to write about Medea came the assumption: of course, they said, you will be looking at the patriarchy as the issue in her behavior. And when I replied that indeed I was not going to be looking in that direction, but rather at Medea herself and at the meaning intrinsic to her acts and her story, interest in my work evaporated and they declined to serve on my committee. Though long a feminist myself, I had been absent from developments in academic feminism. It had escaped my attention that there were “right” ways and “wrong” ways to study women, both real and mythological, and clearly considering Medea as anything other than a victim of the patriarchy was the “wrong” way. 

It is human nature to push away that which we fear or do not like in ourselves. In A Little Book of the Human Shadow, Robert Bly describes the shadow as a bag that we drag along behind us into which we put any “not me” parts, aspects of ourselves we do not want to own or embrace. Each of us is our own version of Dr. Jekyll and Mr. Hyde. The further away we push those darker aspects of ourselves, the more primitive they become. Medea exists as shadow in any of us, despite our efforts to see ourselves as civilized, kind, tolerant, reasonable. And like all shadows, she threatens to break out into our lives if we do not work to become conscious of her.

I remember, during the trial of Andrea Yates, the Texas woman who a few years ago drowned her children, hearing the comments of many women who firmly proclaimed that they could not imagine the possibility, under the wildest of circumstances, of killing their own children, not even if they were psychotic. It is threatening to any mother to think that she could kill her children. Yet we know from literature and mythology that this is one aspect, though indeed a dark one, of mothering captured for us in Kali, in La Llarona, in the Wicked Stepmother, and in Medea. Our culture prefers to enshrine motherhood and offers us the Virgin Mary as the very model of the perfect mother. All of the darker aspects and feelings of mothering and mothers are split off into the Stepmother, the Witch, the Other. We place as much distance between ourselves and the Dark Mother as we can and when we see her, we persuade ourselves that she is nothing like us. 

As her witness, we sympathize with Medea when she presents herself as victim, when she shows us her pain and suffering over Jason’s betrayal and the loss of her marriage. But she acts out her feelings and in doing so, she creates in us an unease. We feel at once the cheer that she has stuck the knife in Jason so deftly, hurt him so deeply, which arises from our own desires to gain revenge against those who hurt us, and at the same time, repugnance for what she does, as it assails our senses of ourselves as civilized and too nice or sane to do such a thing. It is precisely at this point, where rage and pain and revenge come together, that Medea creates a problem for feminism.

And as I studied feminist version of Medea, by Jackie Crossland in her play, Collateral Damage, and Christa Wolf in her novel, Medea,  I found a Medea quite unlike the one we know from Euripides. The rise in anger about male bias and sexism that came with feminism seems to almost require that women be viewed as heroic and always led by angels of their better nature. Certainly, we see this in the feminist Medea, who in becoming less dark also loses much complexity. 

Feminist thought has struggled to take into account choices made by characters which are not easily admirable or understandable. In the press to make Medea less dark, she becomes less altogether. As she reveals herself in both Crossland and Wolf, she seems diminished from the woman of the righteous anger in the Euripidean plays. Medea, having glimpsed her shadow in those tellings of her story seems to have retreated from herself and attempted to eliminate altogether her shadowy aspects. But, no powers exist without a dark side, and when they are denied, murderous feelings can become murderous behaviors, leaving us to wonder how long Medea can contain her darkness as she struggles to hold her position as the hapless victim or Cassandra-like whistleblower.

Feminist psychologists, from Nancy Chodorow to Jean Baker Miller, have focused attention on women and relatedness. The assumption is that women ground themselves in relationship and it is from this relatedness that women’s power flows, as opposed to that of men based in action against and/or over others. In the process, women are granted a kind of moral superiority and relatedness is idealized. One can see this implication of moral superiority in work from Miller’s Relational School of psychology, goddess spirituality, and ecofeminists. Women are empathic, caring, related and moral. 

And this makes the woman who kills a particular problem because we do not have room in our understanding of women which allows for murderous aggression. 
So I have been wrestling with these thoughts in a paper for more than a year now. And just last week, thanks to DrX, I happened upon a study which seems to demonstrate this reluctance for women to see women as responsible for murder. The study, done in Sweden, was designed to look at gender bias in legal insanity evaluations.

Forensic psychiatric decision-making plays a key role in the legal process of homicide cases. Research show that women defendants have a higher likelihood of being declared legally insane and being diverted to hospital. This study attempted to explore if this gender difference is explained by biases in the forensic psychiatric assessments. Participants were 45 practicing forensic psychiatric clinicians, 46 chief judges and 80 psychology students. Participants received a written vignette describing a homicide case, with either a female or a male perpetrator. The results suggested strong gender effects on legal insanity judgements. Forensic psychiatric clinicians and psychology students assessed the case information as more indicative of legal insanity if the perpetrator was a woman than a man. Judges assessed offenders of their own gender, as they were more likely to be declared legally insane than a perpetrator of the opposite gender. Implications of and possible ways to minimize such gender biases in forensic psychiatric evaluations need to be thoroughly considered by the legal system.

That sentence I made bold -- Forensic psychiatric clinicians and psychology students assessed the case information as more indicative of legal insanity if the perpetrator was a woman than a man.  is what I saw in the feminist Medeas. A reluctance to see in a woman the darkness of  the murderer.

It could easily be argued that feminism has redressed the problems of the patriarchal view of women as needing to be contained and kept passive by emphasizing the value of relatedness. As often happens in a reactive movement, however, what emerges is lopsided and what is overlooked is all of the darker aspects of relatedness, or what we Jungians would call its shadow. Having a large capacity for empathy and relationship for intimacy is certainly a gift, but it must be remembered that not all gifts are blessings. This power women carry is both generative and destructive, something the Greeks understood, but which makes us uneasy.


Sep 18, 2008 10:18 AM

Battle for hearts and minds

Stephen Diamond closes his post today, which is the second of two posts on depression as a disease, with this paragraph:

Today we are engaged in a pitched battle for the hearts and minds of the public as regards the relative roles of biology and psychology, nature and nurture, genes and traumatic stressors, in the development and treatment of mental disorders. Here, I am fighting for the depressed patient's need for more, not less, psychology. But if, for example, the general public and mental health professionals accept, as many already have, the literal materialist notion of depression as disease, or the self-proclaimed "scientific fundamentalism" of evolutionary psychologists like fellow blogger Satoshi Kanazawa--who shockingly claims that parenting (or lack thereof) exerts zero, nada, zip, no influence whatever on personality development and psychopathology--this fight will be lost. 

And I quite agree. BUT the very fact that there is a pitched battle is pretty much unknown to those over whom the battle is being fought -- those who struggle with various and sundry mental disorders and problems in living. As I wrote earlier today, the dominant paradigm is the neurobiological one. That is the one major news outlets publish about, that magazines do cover stories on, that patients and would-be patients receive as they are targeted for advertising for psychopharmacological drugs.

The voice of those of us who see the scene through a different lens is not coming through when the NY Times runs a long story in its magazine on pediatric bipolar disorder without giving more than the slightest nod to the reality that this is a highly controversial subject and one that many have not signed on with. 

It certainly feels like a pitched battle to me but most of the people I know outside of my field even know there is a battle at all. We can't hope to make a dent unless we can get our voices heard.

Sep 15, 2008 3:18 PM

I can't say it better

The pediatric bipolar horror show goes on with the appearance yesterday in the NY TImes of a long article in the magazine by Jennifer Egan. It becomes clearer and clearer to me that the dominant paradigm is that medication is the first line treatment for anything psychiatric, regardless of conflicting data about diagnosis or effectiveness. And I hope someone is looking at how and why this is. I have speculated here about the confluence of turf issues, income, increasing power of insurers, and direct advertising to consumers, but that doesn't tell me why the buy-in on this paradigm is so thorough and deep. 

I can't critique this long article any better than Furious Seasons, with his "12 Problems With The Sunday Times Magazine Piece On Child Bipolar Disorder"      and also      CP&P's "A Closer Look: Bipolar Overawareness Week".  Do read them.



Sep 15, 2008 10:37 AM

Over-prescribed? Yes

Google News alerts is one of my primary tools for keeping up with what is happening the world of mental health. Earlier this week, it coughed up this article:

Use of Antidepressant Medications Common Among People With No Psychiatric Illness: Presented at CPA

The authors of the study surveyed over 20,000 people prescribed who had been prescribed an antidepressant and assessed for the presence of symptoms validating a the diagnosis for which they were allegedly being treated. They found

An analysis of the results showed that among individuals who reported using an antidepressant in the previous year, more than 50% did not meet criteria for any of the diagnoses assessed. The researchers also found that these individuals were significantly more likely to be older, white, and female compared with those who took antidepressants and who also met criteria for a 12-month diagnosis and those who neither had a 12-month diagnosis nor took antidepressants.

More than half,  the majority, of those who were prescribed antidepressants did not meet the criteria for the diagnosis! And that doesn't even address the fact that the criteria and number of possible diagnostic categories have been expanded dramatically. There would be a great hue and cry if more than half of the people prescribed insulin were found not to be diabetic, but this study caused not even a ripple. 

In recent weeks studies have reported that these medications perform only slightly better than placebo, if that, and now that they are prescribed absent indicators for them. Yet the scripts continue to be written. Patents continue to take them and even believe they must do so for the rest of their lives. 

Also note that most of those who did not meet the diagnostic criteria were: older, white, and female 

Whose interests does it serve for these women to believe themselves ill and in need of medication to manage their lives?

I keep asking myself what this means.

Sep 12, 2008 1:44 PM

Whose shadow?

Several people sent me this piece by Deepak Chopra from Huffington Post. They thought that because he used Jung's concept of the shadow that I would find it interesting. And indeed I do but not for the reasons they might have thought. Consider this paragraph from the piece:

She is the reverse of Barack Obama, in essence his shadow, deriding his idealism and exhorting people to obey their worst impulses. In psychological terms the shadow is that part of the psyche that hides out of sight, countering our aspirations, virtue, and vision with qualities we are ashamed to face: anger, fear, revenge, violence, selfishness, and suspicion of "the other." For millions of Americans, Obama triggers those feelings, but they don't want to express them. He is calling for us to reach for our higher selves, and frankly, that stirs up hidden reactions of an unsavory kind. (Just to be perfectly clear, I am not making a verbal play out of the fact that Sen. Obama is black. The shadow is a metaphor widely in use before his arrival on the scene.) I recognize that psychological analysis of politics is usually not welcome by the public, but I believe such a perspective can be helpful here to understand Palin's message. In her acceptance speech Gov. Palin sent a rousing call to those who want to celebrate their resistance to change and a higher vision. 

Obama is seen here as the good guy, the one with the good ideals and values and Palin is the carrier of the opposite - anger, hated and the like, in short bad ideals and values. The assumption is that what "we", i.e. Chopra and the readers of Huffington Post are all on the good side with high-minded beliefs and values, while those who share Palin's beliefs are on the bad side, with base motives and values grounded in hate and resentment.

But doesn't hate and resentment feed "our" dark view of those with whom we disagree? When we mark those with whom we disagree with such value-laden labels are we not doing exactly what we decry in them?

In a sense, yes, Palin is Obama's shadow -- for those who who do not share her values. And for those who do align with her, then Obama is also shadow, for them. Not by virtue of color but by holding values which seem to be opposing hers.

I don't think psychological analysis of candidates as Chopra did in his article is helpful. It is sufficient to make a decision based on the issues, on positions the candidates take. But when psychological labels begin to be casually applied in this way, it becomes all too easy to paint the election as a struggle between the forces of good vs evil. And going down that path can all too easily take us in directions that ultimately will betray our core values, no matter which side we are on.

In his last paragraph, Chopra make a statement that I have no problem agreeing with:

Not just conservatives possess a shadow -- we all do. 

That is certainly true. But then he betrays a lack of awareness of his own shadow when he says:

So what comes next is a contest between the two forces of progress and inertia.

Because it all depends on where you sit which force is that of progress and which of inertia. Of course, those on either side believe they are right. And the more deeply held the values they see in play, the values they espouse, the more likely they are to believe they hold the key to what is right. But it is all relative. And that is something we forget at our peril. It is not a very long jump to go from the way Chopra couches his analysis to seeing those who agree with Palin as evil and deserving to be eliminated. It has happened before in human history, led by people who believed themselves to be the forces of light arrayed against the darkness.

It's an election, a campaign for political office. And yes, the stakes are pretty high. But the struggle is not a final battle between good and bad. And we do well not to cast it in such terms. It is important to keep in mind that the Shadow is of the unconscious, as Jung says

Although, with insight and good will, the shadow can to some extent be assimilated into the conscious personality, experience shows that there are certain features which offer the most obstinate resistance to moral control and prove almost impossible to influence. These resistances are usually bound up with projections, which are not recognized as such, and their recognition is a moral achievement beyond the ordinary. While some traits peculiar to the shadow can be recognized without too much difficulty as one's personal qualities, in this case both insight and good will are unavailing because the cause of the emotion appears to lie, beyond all possibility of doubt, in the other person. (Jung, CW vol. 9ii, para. 16)


Sep 11, 2008 12:59 PM

Is the pendulum swinging?

A commenter recently posted--

On a macro level, isn't it interesting how the pendulum swings. We have gone from insight to a medical model and now are seeing the flaws in the medical model and looking again to the soul for healing.

I wish I were more optimistic, but I must say I believe that there is a very long uphill battle between where we are now and where many of us might wish to be. It takes a very knowledgeable patient to know that there is more than one kind of therapy out there. Indeed, many do not have a clue about differences among the various disciplines to which therapists belong, much less any theoretical differences. And why should they? We have made little or no effort to provide maps of the therapy terrain. So for most people, if they are willing to consider therapy at all, the choice is about who is close and takes their insurance. The bulk of what we talk about here then is very much inside baseball stuff.

Even in the medical community, there is very little knowledge or understanding about different psychotherapeutic approaches. Unless a physician has him or herself experienced therapy, most of what they know is what they were taught. And the curriculum has been CBT and meds all the way for some years now.

I have said before and repeat now that I do not believe that there is much future for psychodynamically oriented psychotherapy under the medical model. That model moves more and more toward a brain disease theory of emotional problems and scorns the value of depth. I think we need to think of ourselves more in the realm of alternative health or even personal education. Which mean forgoing third party payments. In all likelihood in your town there are alternative health practitioners of all kinds who cannot accept insurance as payment. To say nothing of cosmetic surgery which is not covered. Yet people find the money to pay for them because they believe their lives will be better. We need to do the same thing. And learn to talk about why we believe that the depth therapies are worthwhile. 

My son recently started an MSW program, planning to become a therapist. In Maine, community mental health centers are not now hiring therapists, having gone to a medication + case management model. Those centers were where social workers and mental health counselors used to do internships and field placements. But if those students want to be therapists, it may well be that college and university counseling centers are the only places still offering what they need. Where will would-be therapists find training outside the classroom? And will any of those places lean toward anything other than CBT? 

Like a said, we are a long way away from nirvana.

Sep 8, 2008 10:57 AM

Catching Up

Lots of interesting things to report since my last post -- so today is a catch up day.

1. Reporting on a study done in Finland, Dr Shock MD PHD  gives us this:

Long-term psychodynamic psychotherapy is superior in the long term to short-term psychodynamic psychotherapy. Short-term produces benefits more quickly than long-term therapies. After 3 years of follow-up, however, the situation was reversed with a stronger treatment effect in the long-term psychodynamic treatment group both for patients with depressive and anxiety symptoms.

If a patient is capable and will benefit from psychodynamic psychotherapy which should be assessed by professionals before hand, than this kind of treatment to my opinion can be of great help to them not only for their complaints but also on the longer term.

Now this study doesn't surprise me at all. Cognitive behavioral therapy gained support because it is easy to design studies of it and because it fits with the current dominant paradigm in psychology and mental health. Insurance companies prefer it because it is short term. It is fairly easy to teach. So I love this longer term outcome study revealing that deeper work has better long term results.


2. Be sure to read this entry from Steve Diamond in his Psychology Today blog which he concludes :

 I submit that depression is not a disease that should be treated in the same way as say, diabetes (which itself is known in many cases to be stress-related). It is a biopsychosocial syndrome requiring far more than pharmacological intervention. The unfortunate fact that most contemporary psychotherapy--including CBT--fails to penetrate to the heart of the Hydra in major unipolar and bipolar depression underscores the desperate need for more effective psychotherapy rather than proving a biological cause for these devastating disorders.

Yup. Meds can, but do not always help with symptoms, but long lasting change requires getting inside and working on what it is that creates the depression in the first place.

3. More less than rosy news about medications, this study --"The persistence of the placebo response in antidepressant clinical trials" --

Abstract

Our objective was to assess the persistence of the placebo response during at least 12 weeks of continued placebo administration in depressed patients who have responded to 6–8 weeks of acute placebo treatment. We identified 8 placebo-controlled antidepressant trials with a total of 3063 depressed patients in which, after acute phase placebo treatment, placebo was continued for more than 12 weeks. The number of patients entering the continuation phase and percentages relapsing during this phase were determined. Based on the total number of patients entering the continuation phase 79% of placebo responders remained well (did not meet relapse criteria) during this phase compared to 93% of antidepressant responders. Although significantly more patients on placebo than on antidepressants relapsed in the continuation phase, 4 out of 5 placebo responders stayed well. The widely held belief that the placebo response in depression is short-lived appears to be based largely on intuition and perhaps wishful thinking.


Sep 4, 2008 9:29 AM

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