Our expert says:
No anatomist, let alone anatomy student, let alone at an Osteopathic School, is qualified to comment on matters of neuro-biochemistry.
And what you neglect, Mark, is the blatant doubel standards you are applying. Despite a significant body of scientific research showing benefits from using these drugs, you reject all that because an unqualified person thinks they could be faulty. But you recommend insead "alternative remedies" when in the entire universe, not one single shred of evidence exists that ANY alternative therapy is of the slightest benefit whatsoever. How dare you describe ANYTHING as "based on unproven science" when you airily recommend therapies without any proof whatever ?
IF you are to be credible, you need to apply the same standards to each of the alternatives you are supposedly comparing.
And anhy Medical Aid that covers visits to any alternative therapist / quack, is blatantly and disgracefully wasting their customers money.
"These drugs " should be used only very sparingly and cautiously in children, yet one has to recognize that serious Dpresion can ocur in kids, among whom suicide is not rare, and alternative remedies are perilous.
Nobody should be brow-beaten into taking any treatment ---not merely drug industry mediations --- people ought to be very cautious about ANY therapy offered to them without science and evidence to back it --- such as Scientology, "natural" remedies, and hypnosis. But I can't help feeling, from the tone and content of your postings ( under various names, but I can read the incoming IP address, remember, so just stick to one nickname ) you sound very reminiscent of the "useful fools" used by Scientology to try to discredit psychiatry, their rival for profit-making, in marketing totally unproven and wildly unrealistic theories and treatments. Giving up on providing any evidence that theyr treatments work, they content themselves with attacking orthodox reatments which do have such evidence.
Mike, don't let amateurs like this mislead you. There is an enormous volume of excellent and weighty reseach about the workings of the brain, a topic which is so immense and complex as to be hard to summarize. Because nobody wants to drill holes into people's skulls and extract live brain samples for analysis, research methods have to be subtle and indirect. The relevance of serotonin is a theory, and a reasonable one. If a drug which predominantly boosts the availability of serotonin helps a large proportion of depressed people to become less depressed, it's fairly reasonable to asume that low serotonin levels or availability might be part of the causation or process of Depression.
But Mike, no competent psychiatrist would prescribe Prozac to "mellow" someone or for somone not suffering from a severe and distinct psychiatric condition.
And Michelle, I think you acidentally misquoted a sloppy sentence in the original article ---there isn't a shred of evidence that "psychotherapy" is equivalent to drugs in effectiveness in treating Depression --- all the evidence shows that one specific form, Cognitive-Behaviour Therapy, can be equivalent ; and that most other forms of psychotherapy, espcially the analytically-oriented, are useless or worse.
Peter Breggin is an eccentric who seems obsessed with eradicating the SSRI's, and sems to focus on nothing else. Notice that when Carte Blanche wanted to do a piece knocking these drugs, they flew to interview him, apparently unable to find any other person so reliably negative. His views are NOT widely accepted in the scientific and medical community. I don't recognize the journal "PLos Medicine" --- what is it ?
Now The Wall Street JOurnal is indeed a generally reputable paper --- but you have here a journalist, lacking scientific qualifications, uncritically summarizing this single paper she found in a journal. And we remember so often when major papers, including the New York Times and other highly repurable journals have found reporters who invented stories and the evidence to prove them --- I'm sure she is doing a fair summary of this particular article, but past experiences forbid us from accepting any journalistic article in any paper or journal, as a reliable source.
And the advantage of science is that it encourages, indeed demands, this sort of questioning of current theories, an attempts to disprove them. Notice too, that Mark actively misuses this aticle and the entire debate --- they are not quoting ANY evidence that SSRI's do not work as effective antidepressants -- the argument is entirely about HOW they work,. And that is fruitful. The neurogenesis theory is a very promising one, and it fits with the observation many of us have pointed out for decades --- the lag-time before any antidepressant shows distinmct antidepressant effects has to be significant ( and its also a reason why I am deeply dubious when any new antidepressant is marketed as working much more quickly than the others ).
You can see how naive and devoid of practical experience are the Anatomist and the journalist, when she writes falsely that the advertising of SSRI's is somehow "keeping patients from a therapy that will help them more." You will notice in this forum that I am second to none in promiting the use of CBT. But no drug advert keeps anyone from having CBT, and we encourage their combined use.
What limits it's use is several important factors. Medical Aids, none of wich seems interested in really good medical / psychiatric advice on their policies, reward doctors more for prescribing medications than for sitting talking with patients, as CBT requires. The payment system actively discourages any form of psychotherapy, which requires TIME, something they're very reluctant to pay for. A surgeon might get paid more for a complex op that takes longer, a shrink is not. Within State health services, the administration is so lousy, and the workload so high, that doctors and shrinks cannot aford the time to provide such counselling, in most instances, and are pushed towards the quickest possible solution --- writing a prescription.
Another factor limiting this is the slowness of Medical Schools to provide training in CBT, and reluctance to recognize that, so long as a proper diagnosis has been made by a properly trained shrink, other health professionls can also be trained to provide the therapy well and efectively. There are few opportunities for existing shrinks to learn the technique, and no incentives to do so. The Medical Council requires doctors to undertake continuing education, but in a highly stupidly designed course which allows a handful of people and organizations to make a lot of money by providing sub-standard or unneeded trai9ning, and which does not encourage this sort of much needed training.
Finally, the Council's obsolete and anti-competitive rules limiting anything they conside to be "advertising" by health practitioners, makes it almost impossible for patients to discover who has had relevant training and can provide CBT.
So, where does all this debate get us ? SSRI's DO WORK, this is not the issue being challenged. Exactly how they do so is irrelevant to someone who needs an effective treatment right now. It is very relevant to science in that the better we understand how they work, the better we might devise other treatments which will do exactly what is required, even more efficiently, and perhaps with less side-effects. And CBT does work, nobody with any sense denies that, but there are problems which need to be urgently addressed, to make it much more widely available.
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