Bernards Voices

MSNBC reports: Meds no better than placebos for all but most severely depressed

CHICAGO – Mild, moderate and even some cases of severe depression might be better treated with alternatives to antidepressant drugs, which do not help patients much more than an inactive placebo, researchers said on Tuesday. But for those with the most severe forms of depression, the medications have significant benefit.

(Only) 2 families of anti-depressants, paroxetine (paxil) and imipramine, were studied.

The so-called placebo effect is powerful in treating depression, where people believe they are helped even though they are taking an inactive sugar pill, DeRubeis said.

My own personal experience is that depression is a very hard nut crack. I like what Peter Kramer says in Against Depression–that it should be attacked vigorously before it deepens and becomes chronic.

Don’t let articles like this one at MSNBC be an excuse not to get treatment.

At least 27 million Americans take antidepressants, nearly double the number that did in the mid-1990s, according to a study by Columbia University and University of Pennsylvania researchers reported in the Archives of General Psychiatry.

More than 164 million prescriptions for antidepressants were written in 2008, totaling nearly $10 billion in U.S. sales, according to IMS Health. Global sales were twice that.

We need more science.   I’m all in favor of science.  Prozac, not mentioned in the MSNBC article, may have an unanticipated mechanism for helping.

From the New Scientist:

At Yale University, Ronald Duman and his colleagues began to see ways of adapting the old theories to take account of the new brain findings. After all, treatment with Prozac and other antidepressants is often amazingly successful. Maybe the monoamine theory was not entirely wrong. They noticed that Prozac and some of the other drugs increased levels of a substance called brain-derived neurotrophic factor, or BDNF, in the hippocampus. BDNF was originally identified as a “growth factor” involved in the development of the nervous system, but it is now known to be important for sustaining and protecting neurons in the adult brain. Duman, along with his colleagues George Henninger and Eric Nestler, now at the University of Texas Southwestern Medical Center in Dallas, proposed a “neurotrophic theory” of depression, in which the antidepressant effects of drugs like Prozac could be attributed to the way they keep cells alive in the hippocampus.

A hard science article from the National Academy of Sciences on the pharmacology of prozac.

A short survey of depression research at Yale. When you are reading the literature you also see things like the combination of anti-depressants, when combined with talk therapy, yield the best results. Dr. Sanacara at Yale is exploring whether the meds are increasing the brains plasticity, and therefore more receptive to therapy.

Leonard Lopate interviews Buzz Aldrin about his memoir.

Aldrin sprinkles in ideas from time to time about depression, anxiety, alcoholism throughout the interview. It is all worth listening to.

What were Aldrin’s first words responding to questions about his depression?
“I was part of a structure.” After he walked on the moon, the purpose and structure evaporated.

“getting the brass ring”
“maybe in the eyes of some … undeservedly”
“highly competitive environment” “prima donna, ego, society”

Stories about NASA and astronauts always draw me in.  I grew up in Nassau Bay across from NASA Johson Space Center in Houston, Texas. My dad worked there as a chemical engineer.  My sisters babysat for kids when their dads were on missions.  Some of my friends had dads in space.  Tour buses circled the neighborhood from time to time.  I was interviewed by a Frenchnewspaper woman when I was 8 years old during the Apollo11 mission.

Nathan Rabin, an editor at the Onion, talks about finding rescue in pop culture.

He talks directly about being “tremendously ashamed” and “guilt-ridden” as a child.
Was hospitalized, went thru foster care …

Why did he write his memoir, The Big Rewind?
He wanted to “own his life story and not have it own” him.
Pop culture gave Rabin the tools “to fight depression.”

Having listened to podcast, and not having read the book, my interpretation of the pop culture rescue is: 1st just the pure entertainment, distracting from the internal rumination, etc. 2nd, he sees he is not alone. And maybe 3rd, finding a purpose/goal. But we can’t understate the importance of finding the right anti-depressants.

Researchers offered half of youngsters and their parents an eight-week course of “cognitive behavioral therapy.” In these hour-long sessions, parents learned how to recognize things they were doing that might make their children anxious — such as being overprotective or worrying out loud. Children also learned coping skills, according to the study, in the June issue of the Journal of Consulting and Clinical Psychology, released Monday

Clik on this url to listen to podcast (upper right corner, little arrow below “Listen:”)

http://www.sciencefriday.com/program/archives/200903275

Brain-imaging studies indicate that a thinning of the right hemisphere of the brain may be linked to an increased risk of depression. Writing in the Proceedings of the National Academy of Sciences, researchers report that people at high risk of developing depression had a 28 percent thinning of the right cortex, the brain’s outermost surface, compared to people with no known risk of depression. The thinning was not linked to actual depression — just an increased risk of developing depression. Researchers said that the discovery that there was a structural link in the cortex to depression was surprising, and plan more imaging and genetic studies to expand on the finding.

 One of the interesting things I learned from this podcast, is that a lot of the research on depression has been focused on the amygdala and hippocampus–centers of emotional processing.  This study was focused on the cortex … the more cognitive part of brain.

Related articles:

http://www.nytimes.com/2009/03/25/health/25brain.html?_r=1&em

“If you have thinning in this portion of the brain, it interferes with the processing of emotional stimuli,” Dr. Peterson said. “We think that’s what makes them vulnerable to developing anxiety and depression — it essentially isolates them in an emotional world.”

http://blogs.discovermagazine.com/80beats/2009/03/25/brain-scans-may-be-able-to-predict-depression-risk/

While studying treatments for depression in rural Africa, Andrew Solomon has an overly intimate encounter with a ram.

List to the moth podcast: http://s3.amazonaws.com/themoth.prx.org/wp-content/uploads/andrew-solomon.mp3

http://www.themoth.org/

The Moth is dedicated to promoting the art of storytelling. We celebrate the ability of stories to honor the diversity and commonality of human experience, and to satisfy a vital human need for connection. We do so by helping our storytellers to shape their stories and to share them with the community at large. One goal of The Moth is to present the finest storytellers among established and emerging writers, performers and artists; another is to encourage storytelling among populations whose stories often go unheard.

Christopher Lukas’s Hungarian-German-Jewish family has a history of suicide and depression. His new memoir about his family’s legacy of mental illness is Blue Genes.

http://www.wnyc.org/shows/lopate/episodes/2008/10/15/segments/112548

Dr. Peter Kramer’s 2005 book, Against Depression, blows me away. I have read a lot of books in the last couple of years, but this is a rare one, that has me jotting notes on every page.

His chapter 12, “Magnitude,” answers the question: how bad is depression:

“Depression is the most devastating disease known to human kind.” (Researchers measure this statistically in terms of “good days” lost.)

In 1996, the most extensive global-burden-of-disease study, conducted by the WHO, the World Bank, and Harvard, concluded that “depression will be second only to ischemic heart disease–in terms of disability caused.”

“Estimates put the annual workplace cost in … America at over forty billion dollars.”

“The best studies show that over 16 percent of Americans suffer major depression in the course of a lifetime.”

“Depression often begins in adolescence. A recent study looked at children between the ages of twelve and seventeen, a stage of life when illness is rare. In the prior six months, 7 percent of boys and almost 14 percent of girls had met the full criteria for major depression.”

Impact on the elderly, “researchers evaluated more than 5000 mean and women age sixty-five and older … over a six year period. Those with high depression scores were over 40 percent more likely to die than those with low depression scores.”

In a cardiac study: after controlling for variables like social class, health risk factors (such as smoking), and other concurrent disease, depression still accounted for a 24 percent increase in deaths–from such causes as heart attack and pneumonia. “Think of it: a cardiac study that finds depression as deadly as congestive heart failure.”

These statements all relate to major depression. Earlier in the book, on page 69, Kramer writes:

“Depression is characterized less by acuity than duration. Depression is what settles in to stay.” 

In these excerpts, I feel like I’ve done the book a disservice. I’m an engineer. Facts are my friends. So I start with the numbers. But Kramer’s writing is clear, convincing, artful. As I make my way through the book I see myself shifting seamlessly from one role to the next: patient, father, child, husband.