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Have antidepressants turned an episodic illness into a chronic one?

A

Apotheosis

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In his March 1 article in the New Yorker, Louis Menand wrote that the NIMH’s STAR*D trial showed that antidepressants produced a 67% recovery rate, which was “far better than the rate for placebo.” As I noted in a previous post, the notion that antidepressants produced a “67% recovery rate” was highly exaggerated. But my focus in this post is on the second part of that statement: What do we really know about the long-term recovery rate for unmedicated depression?

Now answering this question thoroughly involves telling a complicated history of science that has unfolded over the past forty years. It’s a history that I relate in Anatomy of an Epidemic, a book that will be published in April. But here’s a thumbnail version of that history.

In 1921, the great German psychiatrist Emil Kraepelin reported that patients hospitalized with manic-depressive psychosis had fairly good long-term outcomes. “Usually all morbid manifestations completely disappear; but where that is exceptionally not the case, only a rather slight, peculiar psychic weakness develops.” In a long-term follow-up study, sixty percent of Kraepelin’s 450 “depressed-only” patients experienced but a single episode of depression, and only 13 percent had three or more episodes.

Other investigators in the first half of the 20th century, both in Europe and the United States, reported similar outcomes. In 1972, Samuel Guze at Washington University Medical School reviewed the outcomes literature for depression, and he determined that in follow-up studies that lasted ten years, 50% of people hospitalized for depression had no recurrence of their illness. Only a small minority — one-in-ten — became chronically ill.

With this evidence in mind, the NIMH regularly advised the public during the 1960s and early 1970s that the long-term course of depression was fairly benign. “Depression is, on the whole, one of the psychiatric conditions with the best prognosis for eventual recovery with or without treatment. Most depressions are self-limited,” explained the NIMH’s Jonathan Cole in 1964. In 1969, Washington University psychiatrist George Winokur wrote that “assurances can be given to a patient and to his family that subsequent episodes of illness after a first mania or even a first depression will not tend toward a more chronic course.” Five years later, the NIMH’s Dean Schuyler concluded that most depressive episodes “will run their course and terminate with virtually complete recovery without specific intervention.” – read the rest here
 
oneday

oneday

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:) Hi Apo,

Yes this is important stuff - I read the whole piece/blog. I'd noticed myself that depression was being talked about differently over recent years, as the piece says - as having a poorer 'prognosis' now. And the piece suggests the same as being true for bipolar/manic depression. Yes, as the piece asks - is this a result of treatment, particularly medication? (or at least the ways these drugs are used these days)?

I also wonder how much it might have to do with the way that we've been taught to think about depression now, i.e. as a biomedical issue, as a fault of our genes and/or brain chemistry, that we can do little about except take pills. And I also wonder about the effects of modern advanced capitalist, free-market consumerist society - about the kind of misery our society, our way of living, produces.
 
A

Apotheosis

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I also wonder how much it might have to do with the way that we've been taught to think about depression now, i.e. as a biomedical issue, as a fault of our genes and/or brain chemistry, that we can do little about except take pills. And I also wonder about the effects of modern advanced capitalist, free-market consumerist society - about the kind of misery our society, our way of living, produces.
Hi, & yes, these are important points. I wonder about all this stuff too.

How much of the prognosis of all MH issues & difficulties is to do with being bombarded with the idea that they are all almost totally bio-medical issues? & then whatever the complaint to have drugs thrown at the situation.

I think such attitudes are very unhealthy; & usually absolve people of a lot of personal responsibility; & the very resources that they actually need to deal with these things.

Modern 'advanced' capitalist, free-market consumerist society - has a huge amount to answer for here, imo. Maybe it isn't long before the lights go out? Then we shall really see what people are made of.
 
SimonB

SimonB

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Yes people lying down to MH illness.....without any real evidence to...interesting!
 

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