Friday, October 22, 2010

Of suppositions & sugar pills. Friday, Oct. 22, 2010.

“My recovery has been an evolution, not a sudden miracle.” – Patty Duke

Like a nasty rash, it keeps spreading again and again – provoking confusion, hopelessness and even fear for people taking antidepressants.

A meta-analysis of meds’ effectiveness, published last winter in the Journal of the American Medical Association, seemed discouraging to say the least. The presses were rolling, and a three-word summary of the study – “ANTIDEPRESSANTS DON’T WORK!” – flooded the traditional media as well as the blogosphere.

Perhaps most visible was Newsweek’s cover story, “The Depressing News about Antidepressants,” with the subhead, Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.

But that’s not what the results of the analysis actually said – and as a 25-year veteran journalist who also suffers from depression and bipolar, I’m going to call this journalism what it is: bullshit.

Don’t get me wrong. I’m no friend of Big Pharma. I resent the hell out of the pharmaceutical companies that charge outrageous amounts of money for these medications even as they spend billions to persuade TV-watchers to ask their doctors for Happy Pills that will solve all their problems. Not only that, but I’ve suffered extreme side-effects from taking the wrong meds. (Come to think of it, I’m not thrilled about the side effects of the right ones, either.)

But the meta-analysis didn’t say that meds don’t work. It said, “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial (emphasis mine).”

Allow me to put this into English: “If you’ve got a case of the blues, antidepressants probably won’t help you. But if you are very severely depressed, antidepressants can be very effective.” I’d like to add, “And they can save your life.”

That’s what frustrates me every time I read a reference to the AMA report. I fear it can lead people to stop taking their meds. For someone who is mildly, or situationally, depressed, this will save them a few bucks. But for someone with severe, unrelenting, clinical depression, the result could be deadly.

What we really have here is not the wrong meds, but the wrong people being studied. No one would study a group of people without cancer, give them chemotherapy, and then announce that chemo doesn’t cure cancer. But that seems to be what happened with this meta-study.

Further, the abbreviated report simply increases the stigma people with the most severe depression already face. If meds can’t treat it, then your depression must not be a medical illness. If it’s not an illness, then it’s caused by your thoughts. If you try to change your thoughts and your depression doesn’t lift, you’re just not trying hard enough.

When I was experiencing what I would learn later was a mixed episode, I was determined to get better – without meds, and with Dr. David Burns’ Cognitive Behavioral Therapy. This therapy is ideal for situational or moderate depression – it works amazingly well. But – based on my own experience only – Dr. Burns’ assertion that CBT works as well as medication even for severe, clinical depression is overly optimistic. I filled up seven notebooks with my “cognitive distortions.” I’ve never tried so hard at anything in my entire life. And I wound up attempting to kill myself.

It wasn’t until I had been on several medications for a period of time that my mood began to even out. Believe me, I experienced no placebo effect. In the beginning, I felt hopeless that any medication would work for me; later, there were meds I had faith in that did nothing. In fact, the placebo effect is least likely to be a factor for those who are the most severely depressed.

You see, until we found the right “cocktail,” I was truly too sick to help myself. I respect those for whom therapy was an adequate cure, but please don’t judge me for needing meds as an adjunct. Perhaps now I’m ready for that next step – stable enough to try CBT again. But – for me – it’s medication that has brought me here.

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