As a General Practitioner with an interest in Psychological issues, I
have some comments and further questions regarding this study. It seems
clear to me that if 47% of patients improved with placebo and extremely
minor psychological support, then both active treatment groups were
responsible for only an additional 7 and 14% improvements respectively.
Also a further 40 to 50% of patients remained without improvement despite
treatment! This does not say much for the supposed efficacy of
antidepressant treatment.
Surely a more pressing and potentially fruitful area for research is
in the 47% who improved with placebo. By de-nominalising the word
"Depression" and turning it back into a process with a beginning middle
and end may shed more light. Just exactly HOW did this gruop get
depressed? What were the particular strategies they used? How did they
talk to themselves? What type of visual imagery did they produce? More
importantly, how did these internal strategies change when they got well?
By modelling how people successfully overcome depression without
medication we may find some very important and worthwhile strategies.
This paper, for me, only seems to draw attention to how relatively
ineffective antidepressants really are in a condition which for many in
General Practice gets better in 5 to 9 months regardless of what you do.
At the risk of being very cynical I suspect that the pharmaceutical
industry is driving this issue forward. Let's face it, they sponsor much
of the research in Depression, and are unlikely to help fund any study to
look at what really makes the difference in those who recover
spontaneously or with placebo.
Rapid Response:
Depression; Just exactly HOW do you do that?
Dear Sir,
As a General Practitioner with an interest in Psychological issues, I
have some comments and further questions regarding this study. It seems
clear to me that if 47% of patients improved with placebo and extremely
minor psychological support, then both active treatment groups were
responsible for only an additional 7 and 14% improvements respectively.
Also a further 40 to 50% of patients remained without improvement despite
treatment! This does not say much for the supposed efficacy of
antidepressant treatment.
Surely a more pressing and potentially fruitful area for research is
in the 47% who improved with placebo. By de-nominalising the word
"Depression" and turning it back into a process with a beginning middle
and end may shed more light. Just exactly HOW did this gruop get
depressed? What were the particular strategies they used? How did they
talk to themselves? What type of visual imagery did they produce? More
importantly, how did these internal strategies change when they got well?
By modelling how people successfully overcome depression without
medication we may find some very important and worthwhile strategies.
This paper, for me, only seems to draw attention to how relatively
ineffective antidepressants really are in a condition which for many in
General Practice gets better in 5 to 9 months regardless of what you do.
At the risk of being very cynical I suspect that the pharmaceutical
industry is driving this issue forward. Let's face it, they sponsor much
of the research in Depression, and are unlikely to help fund any study to
look at what really makes the difference in those who recover
spontaneously or with placebo.
Yours sincerely,
Lewis Walker FRCP.
Competing interests: No competing interests