Tuesday, May 5, 2009

Look for Me on "60 Minutes"

Well, not exactly (and no thank you). But lacking both time and other pressing concerns today, I belatedly take note of a passing mention of the humble blog in Melissa Healy's health column in the Los Angeles Times last month.

The common mantra now is that if you have depression, seek treatment because it is a treatable illness. By all means seek treatment, but part of psychiatry's soft underbelly (well, okay, psychiatry is really pretty soft all over, a real pussycat) is the weakness of its antidepressant treatments.

Based on both my clinical experience and my understanding of the literature, I don't buy the argument that antidepressants are a vast fraud, no better than placebo. But they're certainly not as robust as many would like to believe.

Often in this blog I have been critical of psychiatry, and the profession has left a lot to be desired in terms of the results it delivers. And I know that the most puerile response to criticism of any field is to say, "Well, do you think you could do better?" As my recently profiled favorite Samuel Johnson put it, one needn't be skilled at making tables in order to offer an informed critique of a particular table.

However, when the antipsychiatry folks shake their heads in disgust when patients end up on multiple medications, often "off label" and carrying significant side effects, I can't help wondering what they would do if faced with the patients psychiatrists see. Tell them to eat healthy food, get fresh air and exercise, find God, get married, get divorced, get a therapist? What if you do all these things and a hundred more, and try all the FDA-indicated treatments for depression, and years go by, and nothing happens? Well, you get creative, in a sometimes desperate attempt to alleviate suffering. It is easy to disdain the endeavor in a blog, with no patient sitting across from you.


Retriever said...

Good post. My family members and I will snarl at the next person who snarks about how depressed people are just whiners, that depression is treatable, that it can be cured in six sessions of CBT and with one course of SSRIs. Treatment-resistant doesn't even begin to describe the disorders that afflict my relatives. And I do not mean that the patients are resistant to seeking, paying for, and following the advice of their doctors. But rather that nothing helps completely or for long. Some of us have found very good doctors to whom (not to meds or one kind of formulaic therapy) we owe our lives.

Anonymous said...

Anything less than a cure is worthless.

...accurate, economical, permanent, painless, convenient, organic, preservative free, shrinkwrapped, healthy but tasty - they want it all...

People want the reassurance that if their brains starting flipping, they can be guaranteed a painless tune-up; and if they can buy the treatment in a supermarket with free coupons, even better.

They canned cheese, did they not? A cure for depression can't be any harder....

Novalis, should Dr Phil be feeling threatened? Can I be on your show when you're famous?

Novalis said...

How can you speak of Dr. Phil in the same breath as the leviathan, the juggernaut, the media empire that Ars Psychiatrica has become? It's grown too large; what have I done?

To paraphrase Stalin, a million viewers is a statistic, while a dozen consistent readers is...a comedy.

Anonymous, are you sure you're ready for prime time?

Dr X said...

Some people regard every side effect as a direct, biochemical effect of the drug itself, while dismissing any antidepressant effect as a placebo effect. Of course, whether an effect is considered a side effect or a main effect depends upon the intended effect. So, when Wellbutrin is used for smoking cessation, what do the skeptics think about the appearance of any antidepressant side effects? Sorry, I’m being a bit snarky to make a point about what seems to be a bias among the hard line skeptics.

Anonymous said...

Hah! Sacrilege! I shudder at the mere thought of that arrogant fraudulent SELL-OUT! ..(I won't mention that unmentionable name again...only in passing cynicism, mockery, contempt, *spit*). 'what was I thinking!'..

You'll need a disguise in public soon to avoid being mobbed...celebrity is such a curse/blessing. You can borrow my anonymity if you like - but I'm keeping my complexes.

Prime time? For sure - but I'll have to be silhouetted or pixelated to maintain my integrity as a non-entity.

' ...a thousand fools/Dr Phil (there it is again, that name! - it's like a nasty tic/tick) viewers do not make one wise man/Ars Psychiatrica reader'