If researchers used better patient selection methods when testing antidepressants, the effectiveness of those medications would be more accurately measured and confirmed.
Read more: Adverse Responders and Antidepressant Effectiveness
Here's the latest news and some other useful reading on the debate over antidepressants.
First a study that concludes antidepressants are more effective than placebo for all depressed patients, not just the most severely affected: Benefits From Antidepressants: Synthesis of 6-Week Patient-Level Outcomes From Double-blind Placebo-Controlled Randomized Trials of Fluoxetine and Venlafaxine. The authors state that "the results do not support previous findings that antidepressants show little benefit except for severe depression. The antidepressants fluoxetine and venlafaxine are efficacious for major depressive disorder in all age groups, although more so in youths and adults compared with geriatric patients."
Another new finding is reported in this link to a recent article from Psychiatric Times by Arline Kaplan called "On the Efficacy of Psychiatric Drugs." (Free registration required.) The researchers conclude from an extensive review of drug versus placebo studies that the effectiveness of psychiatric drugs is in the range of most of the drugs used in medicine.
Finally, a pair of abstracts from opposing scientific articles on antidepressant effectiveness: CON and PRO.
Nothing is more antithetical to feeling empowered than depression. Energy is depleted, fear is exaggerated, hope is forgotten, stigma is everywhere, enjoyment is nowhere, and treatment is a punch line for late night TV. Where exactly are you going to find empowerment in that haystack?
To demonstrate how the TTDI Depression Consultant app for iPad works, let’s start by reading "Do Antidepressants Help With Depression?", the moving personal story of prolific online writer Nancy Klatz Beal. After using this link to see the article at Helium.com, please use your browser's "Back" feature and return here.
Read more: How did the original TTDI iPad app work in practice?
About 1% of people in the U.S. will experience bipolar disorder at some point in their lives, meaning that they will not only be susceptible to states of depression, but also to opposite intervals of hypomania or mania.
Richard J. Metzner, M.D.
Clinical Professor
Semel Institute for Neuroscience and Human Behavior at UCLA
Founder, DepressionConsultant.info
Bipolar patients have a greater likelihood of switching from depression to mania when receiving antidepressants. Using the primary treatments for this disorder, which are mood stabilizers like valproic acid (Depakote) and/or atypical neuroleptics like quetiapine (Seroquel), may permit safer use of antidepressants, but many bipolar people will do better without them. On the other hand, people with irritable or hostile depressions who don't have mania or hypomania will do much better, in most cases, if treated with calming antidepressants and, if necessary, neuroleptics. Merely being irritable or angry at times, which some call "soft bipolar symptoms," doesn't constitute bipolar disorder.
We strongly recommend that, when bipolar disorder is a possibility, evaluation includes both a bipolar mania scale and the Clinaptica app. If bipolarity is detected by either scale, referral to a psychiatrist or psychopharmacologist is the next step.
Copyright 2012, Scaled Psychiatric Systems, Inc. All rights reserved.
SUMMARY:
We initially saw Jane and Bill in April and Mark in May of 2012. We decided to track their progress online to demonstrate how the Clinapticatm iPad app can assist the pharmacological treatment of mood disorders. All three have done well, as have most patients with whom this method has been tested.
Jane's first test scores indicated a moderate level of depression requiring both calming (M=11.19: see results graphs below for scoring key) and activating (A=13.00). Given her prior history of success on sertraline, we chose to follow Clinaptica's SSRI option. Five weeks later she was in full remission (M=1.09; A=2.63).
Bill's initial scores indicated mania, with exaggerated feelings of well-being (M=-7.00) and over-activation (A=-12.00). Two months after starting the mood stabilizer valproic acid, Bill was also in remission (M=2.00; A=3.50).
Mark's beginning scores showed a mild need for calming (M=7.30) and a mild to moderate need for activation (A=10.68). He was taking both the SSRI fluoxetine 20 mg and the NDRI bupropion XL 300 mg. After three months on bupropion XL 450 mg and tapering off the SSRI, Mark's need for calming and activation were both fully relieved (M=1.11; A=3.97). His anxiety turned out to be primarily related to worrying about his lack of energy.
DETAILS:
Figures shown below are actual screen shots of Clinaptica reports from patients being seen in consultation
"JANE"
April 11, 2012 Jane is a 62 year old married woman who was referred by her primary care physician six months ago for evaluation of depression. She had presented a history of prior treatment with sertraline (Zoloft) but didn't think she needed it again at that time. Today she presents with significantly increased sadness, anxiety and fatigue, which she attributes to increased financial stress. The Clinaptica Depression Consultant app (Figure 1)finds a moderate level of depression (D=24.19) with a need for both calming (M=11.19) and activation (A=13.00) and recommends SNRI or SSRI+NDRI treatment. We elect to start her back on her previous SSRI at 50mg daily and see how she does.
Figure 1
April 26, 2012 Jane returns after two weeks on sertraline feeling a bit better, despite worsening financial stress. Clinaptica shows a slight improvement in all scores (M=10.00, A=12.00). We increase the SSRI to 100 mg daily.
May 31, 2012 Jane is much better today after five weeks on 100 mg daily of the SSRI sertraline. She says she feels like she did before she ever became depressed and appears to be in complete remission. Her Clinaptica scores (Figure 2) are now entirely in the normal range. We continue her current dosage.
Figure 2
"BILL"
April 12, 2012 Bill is a 50 year old unmarried man who was referred to us by a family member. He presents with loquacity, euphoria and reduced need for sleep. Clinaptica (Figure 3) shows no depression (D=0.00) and a manic pattern, with moderately excessive activation (A=-12.00) and mildly excessive calming (M=-7.00). He agrees to begin taking the mood stabilizer valproic acid (Depakote) at 1,000 mg nightly.
Figure 3
April 27, 2012 Bill returns feeling much calmer and less “hyper.” Clinaptica shows a 5.15 improvement in A score and a 2.60 improvement in M score. We advise remaining on valproic acid at the same dosage.
June 1, 2012 After 7 weeks on 1,000 mg daily of valproic acid, Bill appears much less "high" than before, but reports continuing sleep issues. Although his Clinaptica M score is normal (M=2.92) and his A score has improved by 7 points, he still has some residual hyperactivity (A=-5.0). We elect to increase the valproic acid to 1,500 mg daily.
July 13, 2012 After 6 weeks of taking 1,500 mg of valproic acid daily, Bill's manic episode is over. He acknowledges having made some mistakes in judgment while he was manic. His Clinaptica scores are all within normal range (Figure 4), and antidepressant medication is not recommended, nor advisable in the future. We continue the mood stabilizer at the present dose to enable him to maintain his recovery.
Figure 4
"MARK"
May 18, 2012 Mark is a 32 year old single male classical musician who has been depressed most of his life. He was started on fluoxetine (Prozac) 20 mg by his primary care physician two years ago and was using amphetamines recreationally until 3 months ago. Shortly thereafter, he began seeing a psychiatrist who advanced him from bupropion XL (Wellbutrin XL) 150 mg to 300 mg. He says he has not used amphetamines with the bupropion. He complains of continuing low energy and anxiety. Clinaptica (Figure 5) recommends increasing both of his antidepressants sequentially. He feels much of his anxiety is related to worrying that he won’t have enough energy to perform on stage. The bupropion XL is increased to 450 mg.
Figure 5
May 30, 2012 After 12 days of receiving 450 mg of bupropion daily, Mark happily reports increased energy but wishes he could stay focussed and concentrate better on his music. Clinaptica shows a 2.7 improvement in his A (need for activation) score but an essentially unimproved M score. We follow Clinaptica's recommendation to increase the SSRI. He is now going to take fluoxetine 30 mg.
June 14, 2012 Two weeks later Mark's M score has improved by 1.2 points, but his energy has diminished on the increased SSRI, as reflected in an elevated A score of almost 11. We start tapering the dose of fluoxetine to 10 mg.
June 28, 2012 After another two weeks on significantly less SSRI, Mark's A score has improved by 2.8 points, and he describes his energy as "very good." His M score too has improved to normal, suggesting that his anxiety may indeed have been related to concerns about not having the energy to perform at his job. Clinaptica no longer recommends the SSRI, so we decide to try eliminating it.
July 12, 2012 Two weeks later the SSRI is almost discontinued. Mark's A score has improved by another point, and his energy pleases him greatly. His M score remains normal.
August 10, 2012 Having discontinued his SSRI successfully, Mark appears calm and happy. Both of his scores are now in the normal range (Figure 6). He says he looks forward to more work, more play and fewer doctor visits!
Figure 6
Copyright 2012, Scaled Psychiatric Systems, Inc. All rights reserved.