Monday, May 29, 2006

Is Drugging Grandma Forever better than Psychotherapy?

When the press trumpet, "Drugs trounce psychotherapy", it's probably wise to find out what the leader of the study says, instead of a headline hunting sub-editor. Apparently, there recent was a story promoting the drug angle over a talking therapy, and even this psych has issues with the news item:

Found vis the blog BoBo Hits Back

The headlines below demonstrate the profound limitations of getting reliable information from the news. Certainly if it involves any sort of complexity. The links to the four newspaper articles purport to give details of a study on the treatment of elderly people with depression, comparing prolonged drug treatments to a course of Interpersonal Psychotherapy (IPT).

Drugs trounce psychotherapy for blocking depression's return: Gives it you straight and lightweight. It's pretty much worthless in telling you what when on, but conveys a strong and simplistic message.

Elderly with depression benefit from continuing drugs and psychotherapy: This is a better article, but still doesn't really give you a clear sense of what actually happened.

Drugs better for depression: This article mentioned that the psychotherapy treatment was for only 45 minutes, once a month. What sort of therapeutic relationship - the key to all forms of psychotherapy - can be built up which such a fractured
therapy experience. I doubt that I could maintain much therapeutic continuity if I only saw a therapist once a month, and I'm not over 70
(nor depressed).

Maintenance meds cut depression relapse: This articles was the best. It did at least mention the form of psychotherapy being compared - IPT (Interpersonal Therapy) see UK Interpersonal Psychotherapy. Though it didn't mention the monthly timescale.

But there's more: You might expect that if you stuff someone full of antidepressants every day, that they wouldn't get depressed again.
Yet - not really highlighted by any of the articles - 37% of patients who were continually being given anti-depressants over a two year period actually did have another depression. What's going on with that?

[...]

Of course, pushing pills is quick and easy. Being elderly and depressed: facing the breakdown of your bodies functions, facing the isolation that comes with burying your own friends and family, facing the end of your own life narrative and that it's too late to undo the past or live a new better life, facing the scrap-heap of old age in a youth obsessed culture, and facing death. They all seem like perfectly sound reasons for experiencing depression in old age. Thank goodness we have some pills to take the existential pain of it all away!


Sarcasm noted

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