[PAA-Discuss] Fwd: Counterpunch - 5 Myths About Depression Treatments

[rebelljb at aol.com]

-----Original Message-----
From: Vince Boehm <vince_19805 at yahoo.com>
To: undisclosed-recipients:;
Sent: Sat, Dec 4, 2010 5:03 pm
Subject: Levine - 5 Myths About Depression Treatments


**** note:   This is a private list.  I send out alerts, useful news 
items, and comment to a group of mental health professionals, decision 
makers and activists. (OK to repost and to include this header and 
comments).  If you do not want to receive any of these emails, please 
let me know. To preserve privacy,  I blind copy the entire list.     
Vince Boehm  ****




Bruce Levine, PhD  is a clinical psychologist and a friend.  He has 
been in private practice in Cincinnati, Ohio for more than two decades.

Levine's most recent book is Surviving America's Depression Epidemic: 
How to Find Morale, Energy, and Community in a World Gone Crazy 
(Chelsea Green Publishing, 2007), which argues that by not seriously 
confronting societal sources of depression, American mental health 
institutions have become part of the problem rather than the solution. 
The book provides an alternate approach that encompasses the whole of 
our humanity, society, and culture, and which redefines depression (as 
a problematic strategy to shut down pain) in a way that makes enduring 
transformation more likely.


Levine is also the author of Commonsense Rebellion: Taking Back Your 
Life from Drugs, Shrinks, Corporations and a World Gone Crazy (New 
York-London: Continuum, 2003), a protest book. The 26 alphabetically 
ordered chapters of Commonsense Rebellion detail Levine's contention 
that the high national rates of mental illness in the United States are 
really just natural reactions (e.g., discontent and disconnectedness) 
to the oppression of what he terms an "institutional society," which he 
argues causes many to break down psychologically. An earlier edition 
was released in 2001 with the subtitle Debunking Psychiatry, 
Confronting Society — An A to Z Guide to Rehumanizing Our Lives.

Levine is a regular contributor to Z Magazine and The Huffington Post 
and his articles have appeared in Adbusters, The Ecologist and many 
other publications.
I met Bruce in 2003 when I participated in MindFreedom's now-famous 21 
day hunger strike (no solid food), the Fast For Freedom.   His Web site 
is www.brucelevine.net



Vince










http://www.counterpunch.org/levine12032010.html

Weekend Edition
December 3 -5, 2010
Good News for Critically Thinking Depression Sufferers
5 Myths About Depression Treatments
By BRUCE E. LEVINE

A warning: for people satisfied with their standard depression 
treatments, debunking myths about them may be troubling. However, for 
critically thinking depression sufferers who have not been helped by 
antidepressants, psychotherapy, or other standard treatments, 
discovering truths about these treatments can provide ideas about what 
may actually work for them.
Critical thinkers have difficulty placing faith in any depression 
treatment because science tells them that these treatments often work 
no better than placebos or nothing at all, and if one lacks faith in 
adepression treatment,it is not likely to be effective. In fact, it is 
belief and faith—or what scientists call “expectations” and the 
“placebo effect”—that is mostly responsible for any depression 
treatment working. Critical-thinkers can find a way out of depression 
when their critical thinking about depression treatments is validated 
and respected, and they are challenged to think more critically about 
their critical thinking.
Myth 1: Antidepressants Are More Effective than Placebos
Many depressed people report that antidepressants have been effective 
for them, but do antidepressants work any better than a sugar pill? 
Researcher Irving Kirsch (professor of psychology at the University of 
Hull in the United Kingdom as well as professor emeritus at the 
University of Connecticut and author of The Emperor’s New Drugs) has 
been trying to answer that question for a significant part of his 
career.
In 2002, Kirsch and his team at the University of Connecticut examined 
47 depression treatment studies that had been sponsored by drug 
companies on the antidepressants Prozac, Paxil, Zoloft, Effexor, 
Celexa, and Serzone. Many of these studies had not been published, but 
all had been submitted to the Food and Drug Administration (FDA), so 
Kirsch used the Freedom of Information Act to gain access to all the 
data. He discovered that in the majority of the trials, antidepressants 
failed to outperform sugar pill placebos.
 “All antidepressants,” Kirsch reported in 2010, “including the 
well-known SSRIs [selective serotonin reuptake inhibitors], had no 
clinically significant benefit over a placebo.” While in aggregate, 
antidepressants slightly edge out placebos, the difference is so 
unremarkable that Kirsch and others describe it as “clinically 
negligible.”
Why are so many doctors unaware of the lack of superiority of 
antidepressants as compared to placebos? The answer became clear in 
2008 when researcher and physician Erick Turner (currently at the 
Department of Psychiatry and Center for Ethics in Health Care, Oregon 
Health and Science University) discovered that antidepressant studies 
with favorable outcomes were far more likely to be published than those 
with unfavorable outcomes. Analyzing published and unpublished 
antidepressant studies registered with the FDA between 1987-2004, 
Turner found that 37 of 38 studies having positive results were 
published; however, Turner reported, “Studies viewed by the FDA as 
having negative or questionable results were, with 3 exceptions, either 
not published (22 studies) or published in a way that, in our opinion, 
[falsely] conveyed a positive outcome (11 studies).”
Myth 2: If the First Antidepressant Fails, Another Antidepressant Will 
Likely Succeed
In The Noonday Demon, the popular 2001 book about depression, writer 
and depression sufferer Andrew Solomon repeated the then urban legend 
that “more than 80 percent of depressed patients are responsive to 
medication.” Solomon accurately cites a journal article that states 
this statistic; however, following the “reference trail,” I discovered 
that the journal article that Solomon cited refers to a second article 
for evidence of this statistic, but this second journal article 
mentions nothing about 80 percent of depressed patients responding to 
some medication.
The National Institute of Mental Health (NIMH) was aware that there was 
no research to back up the assertion that 80 percent of depressed 
patients improve if they keep trying different medications, so NIMH 
funded “Sequential Treatment Alternatives to Relieve Depression” 
(STAR*D), the largest ever study of sequential depression treatments. 
STAR*D results were published in 2006.
In Step One of STAR*D, all depressed patients were given the 
antidepressant Celexa, and in Step Two, patients who failed to respond 
to Celexa were divided into different groups and received other 
treatments (mostly different drug treatments) in place of or in 
addition to Celexa. If their second treatment failed, there was a third 
and, if necessary, a fourth treatment step.
In every STAR*D treatment step, remission rates were either equal to or 
significantly lower than the customary placebo performance in other 
antidepressant studies, but to the exasperation of many scientists, 
there was no placebo control in this $35 million U.S. taxpayer funded 
STAR*D study. (STAR*D researchers disclosed receiving consulting and 
speaker fees from the pharmaceutical companies which manufacture the 
antidepressants studied in STAR*D.)
In March 2006, NIMH triumphantly announced that 50 percent of depressed 
people saw remission of symptoms after the first two STAR*D steps. 
However, NIMH failed to mention in its press release that in the same 
time it took to complete these first two steps—slightly over 6 
months—previous research shows that depressed people receiving no 
treatment at all have a spontaneous remission rate of 50 percent.
In November 2006, following the completion of all four STAR*D steps, 
STAR*D authors claimed a 67 percent cumulative remission rate, which 
again exasperated many scientists because this number failed to 
incorporate STAR*D’s extremely high relapse and dropout rates. In an 
American Journal of Psychiatry editorial that accompanied STAR*D 
authors’ report, J. Craig Nelson, M.D, stated, “I found a cumulative 
sustained recovery rate of 43 percent after four treatments, using a 
method similar to the authors but taking relapse rates into account.” 
However, even 43 percent turns out to be an inflated rate.
Separate analyses of STAR*D in 2010 by psychologist Ed Pigott and 
medical reporter Robert Whitaker revealed that STAR*D researchers had 
inflated remission numbers by switching mid-study to a more lenient 
measurement, and also by including patients who were not depressed 
enough at baseline to meet study criteria. But even taking the STAR*D 
data as is, Pigott’s analysis revealed that less than 3 percent of the 
entire group of depressed patients who began the STAR*D study can be 
ascertained as having a sustained remission (i.e., actually 
participated in the final assessment without relapsing and/or dropping 
out).
Myth 3: Electroconvulsive Treatment (ECT) is an Effective Last Resort
Andrew Solomon in The Noonday Demon alsostates, “ECT seems to have some 
significant impact between 75 and 90 percent of the time. About half of 
those who have improved on ECT still feel good a year after treatment.” 
Is ECT really that effective?
In 2004, researcher Joan Prudic, M.D. and her team at New York State 
Psychiatric Institute conducted a major study of ECT, which involved 
347 patients at seven hospitals. Reported were both the immediate 
outcomes and the outcomes over a 24-week follow-up period. With respect 
to immediate outcomes, Prudic reported: “In contrast to the 70 to 90 
percent remission rates expected with ECT, remission rates, depending 
on criteria, were 30.3 to 46.7 percent.” Even worse for ECT advocates, 
Prudic noted that, “10 days after ECT, patients had lost 40 percent of 
the improvement.”
There are also studies comparing ECT with a placebo (called “sham 
ECT”). In sham ECT, patients receive muscle-relaxing and anesthetizing 
drugs that routinely accompany ECT, and they are hooked up to the ECT 
apparatus, but they receive no electric voltage. Psychiatrist Colin 
Ross reports, “No study has demonstrated a significant difference 
between real and placebo (sham) ECT at 1 month post-treatment.”
Myth 4: Cognitive Behavior Therapy (CBT) is the Best Psychotherapy for 
Depression
First, the good news about CBT. The only non-drug treatment examined in 
STAR*D was a form of cognitive therapy (which was not fully detailed by 
STAR*D authors and only administered in Step Two). Among those who 
failed Celexa in the first step, three groups in Step Two switched from 
Celexa to one of three antidepressants, and their remission rates 
ranged from 25 to 26.6 percent; but one group in Step Two switched from 
Celexa to cognitive therapy, and its remission rate was 41.9 percent. 
STAR*D researchers did not assess whether any differences in treatment 
effectiveness were statistically significant.
Another group in Step Two maintained Celexa and added cognitive 
therapy, and this “Celexa plus cognitive therapy” group’s remission 
rate was 29.4 percent, not as high as the group that received cognitive 
therapy without medication. This begs the question: Is it also a myth 
that “antidepressants plus psychotherapy” works better than either 
treatment alone? Research psychologist David Antonuccio at the 
University of Nevada School of Medicine reports, “Combined 
psychotherapy and drug treatment do not appear to be superior to 
therapy or drug treatment alone.”
What psychotherapy is best for depression? While Americans hear most 
about CBT, it turns out that CBT or some form of cognitive therapy is 
no more effective for depression than any of several other types of 
psychotherapy. In 2008, psychologists Pim Cuijpers and Annemicke van 
Straten at the University of Amsterdam reported on a meta-analysis of 
53 studies, each of which compared two or more different types of 
psychotherapy for depression. Included were varieties of 
“cognitive-behavior therapy,” “psychodynamic therapy,” “behavioral 
activation therapy,” “social skills training,” “problem-solving 
therapy,” “interpersonal therapy,” and “nondirective supportive 
therapy.” The major finding? “No large differences in efficacy between 
major psychotherapies for mild to moderate depression.”
So, if psychotherapy technique is not all that important, what is? 
Psychologist Bruce Wampold at the University of Wisconsin reviewed the 
psychotherapy outcome literature, examining hundreds of studies and 
meta-analyses, for his book The Great Psychotherapy Debate. Wampold 
unequivocally states that outcome effectiveness does not depend on the 
specific techniques of psychotherapy but instead depends on so-called 
“non-specific” factors such as the nature of the alliance between 
therapist and their client, and clients’ confidence in the therapy and 
in their therapist. “Simply stated,” Wampold concludes, “the client 
must believe in the treatment or be led to believe in it.”
Myth 5: No Treatment for Depression Works
In April 2002, an NIMH-funded study on the antidepressant Zolof, the 
herb St. John’s wort, and a placebo had some curious results. The 
findings were that 32 percent of placebo-treated patients experienced 
remission, better than the 25 percent remission for the Zoloft-treated 
patients or the 24 percent remission for the St. John’s wort-treated 
patients. Most scientists would say that this study shows that neither 
Zoloft nor St. John’s wort worked, but those subjects who had positive 
outcomes with these two treatments would disagree. So, does this study 
show that antidepressants and St. John’s wort are not helpful, or does 
it show that “expectations,” belief,” and “faith” are the likely 
factors that make all treatments work?
When assessing whether a specific treatment is effective, scientists 
are trained to rule out the effect of expectations. Researchers 
evaluate a depression treatment as effective if, in a controlled study, 
the treatment outcome is significantly better than a placebo. However, 
the reality of depression treatments is that expectations, faith, 
belief, and the placebo effect are—far and away—the most important 
reasons why anything works.
In 2004, Heather Krell, M.D. and her group at the University of 
California in Los Angeles examined the influence of patient 
expectations on the effectiveness of an experimental antidepressant. 
They found that among those depressed patients expecting that the 
medication would be very effective, 90 percent had a positive response; 
while among those expecting the medication would be somewhat effective, 
only 33 percent had a positive response. No depressed people were 
included in this study who expected the experimental drug to be 
ineffective, but such nonbelievers, in my experience, rarely report a 
positive response with antidepressants. All treatments can work, but 
rarely do so if one doesn’t believe in them.
A Path for Treatment Resisters: Critical Thinking about Critical 
Thinking
Critical thinking and an absence of self-deception are crucial for 
success in many areas of life, but these same talents can be 
problematic with respect to depression. A more accurate notion of how 
truly powerless one is in a situation (such as family, an organization, 
or society) can result in a greater feeling of helplessness, pain, and 
depression.
 From several classic studies, we know that moderately depressed people 
are, in a sense, more critically thinking than are nondepressed people. 
These studies show that depressed people are more accurate than are 
nondepressed people in both their assessment of control over events and 
in judging people’s attitudes toward them. Researchers Lauren Alloy and 
Lyn Abramson at the University of Pennsylvania in 1979, studying 
nondepressed and depressed subjects who played a rigged game in which 
they had no actual control, found that depressed subjects more 
accurately evaluated their lack of control when either losing or 
winning. And researcher Peter Lewinsohn at the University of Oregon in 
1980, found that depressed subjects judge other people’s attitudes 
toward them more accurately than nondepressed subjects.
Critical thinking also creates a problem for depression treatment, as 
skepticism makes one stubbornly resistant to much of what helps others. 
Specifically, to the extent one has uncritical faith in a treatment, it 
is far more likely to be experienced as successful; but to the extent 
that one is more skeptical about the effectiveness of treatment, one is 
less likely to have expectations that it will be effective, and this 
becomes a self-fulfilling prophesy.
Before modern research borne out this problematic relationship between 
depression and critical thinking, the American psychologist and 
philosopher William James (1842-1910) recognized this reality based on 
his personal experience. James had a history of severe depression, 
which helped fuel some of his greatest wisdom as to how to overcome 
depression.
In The Thought and Character of William James, Ralph Barton Perry’s 
classic biography on his teacher, in the chapter “Depression and 
Recovery,” we learn that James at age 27 described himself as going 
through a period of a “disgust for life” in which Perry describes as an 
“ebbing of the will to live. . . . a personal crisis that could only be 
relieved by philosophical insight.” What was James’s transformative 
insight?
James was a critical thinker and had no stomach for smiley-faced 
positive thinking, but he also concluded that his pessimism might just 
destroy him. With his critical thinking, he came quite pragmatically to 
“believe in belief.” He continued to maintain that one cannot choose to 
believe in whatever one wants (one cannot choose to believe that 2 + 2 
= 5); however, he concluded that there is a range of human experience 
in which one can choose beliefs. He came to understand that, “Faith in 
a fact can help create the fact.” So, for example, a belief that one 
“has a significant contribution to make to the world” can keep one from 
committing suicide during a period of deep despair, and remaining alive 
makes it possible to in fact make a significant contribution.
Critical thinkers are skeptics who have difficulty with belief and 
faith, but depression treatments work to the extent that one has faith 
in them. Instead of viewing themselves as failures for not improving 
with standard treatments, depressed critical thinkers can logically 
acknowledge the downside of their temperament. Myth busting about 
standard treatments enables critically thinking treatment resisters to 
release their pain over “treatment failure.” The pain of failure is one 
of the many pains that results in depression as well as substance abuse 
and other compulsions that are fueled by a need to shut down one’s 
pain. Releasing any pain, including the pain of treatment failure, can 
be helpful.
When critically thinking treatment resisters discover that there have 
been others like themselves who have escaped this conundrum by finding 
something that they could believe in without giving up their critical 
thinking, this can be a jump start for them in finding their own 
particular antidote to depression. William James ultimately let go of 
his dallying with suicide, remained a tough-minded thinker with 
scientific loyalty to the facts, but also developed faith that, “Life 
shall be built in doing and suffering and creating.”
Bruce E. Levine is a clinical psychologist and his latest book is 
Surviving America’s Depression Epidemic: How to Find Morale, Energy, 
and Community in a World Gone Crazy (Chelsea Green Publishing, 2007). 
His Web site is www.brucelevine.net
 






                                                                 

------------------------------------------------------------


List members noted in Green text.

FAIR USE NOTICE: This may contain copyrighted (© ) material the use of 
which has not always been specifically authorized by the copyright 
owner. Such material is made available for educational purposes, to 
advance understanding of human rights, democracy, scientific, moral, 
ethical, and social justice issues, etc. It is believed that this 
constitutes a 'fair use' of any such copyrighted material as provided 
for in Title 17 U.S.C. section 107 of the US Copyright Law. This 
material is distributed without profit.


The information herein shall not be considered an endorsement of anyone 
discontinuing psychiatric drugs. If you are stopping taking medication  
IT IS ADVISABLE TO REDUCE DOSES GRADUALLY WITH EXTREME CAUTION, as it 
is difficult to predict who will have problems withdrawing. It is worth 
getting as much information and support as you can, and involving your 
doctor wherever possible. You will find withdrawal information here.   
http://theicarusproject.net/alternative-treatments/harm-reduction-guide-to-coming-off-psychiatric-drugs
          
                                                       

FOR MORE INFORMATION ON WITHDRAWAL:: Get Peter Lehmann's book, Coming 
off Psychiatric Drugs: Successful Withdrawal from Neuroleptics, 
Antidepressants, Lithium, Carbamazepine and Tranquilizers.  This 
valuable resource comes in US, UK, Greek. and German editions.