A Humbling Reality--Treatments for Depression Often Fail_Boston Globe

March 12, 2006

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The Boston Globe reports (below): " More than 50 years after

psychiatrists began widely dispensing drugs to treat mental illness,

the profession is coming face to face with a humbling reality: Its

treatments often fail, leaving millions of patients [ ] to suffer

while doctors search for something that works. "

Wall Street Journal science columnist, Sharon Begley, wrote in

November 2005:

" Some 19 million people in the U.S. suffer from depression in any

given year. For many, SSRIs help little, if at all. To do better, we

have to get the science right. "

Whenever psychiatry's prescribed treatments have been put to the test

of science each treatment has failed to demonstrate a clinically

significant benefit above placebo. Furthermore, independent scrutiny

has shown that each of psychiatry's treatments poses serious risks of

harm—particularly with long-term use.

Within the last six months, the Globe reminds readers, " three

unprecedented government-funded studies of the most common mental

illnesses -- depression, bipolar disorder, and schizophrenia -- have

underscored just how far modern psychiatry is from ''curing " mental

illness. "

However, psychiatry is anything but humbled by the reality of its

failed theories and treatments. Instead, there appears to be an

inverse relationship between psychiatry's inflated claims /

pronouncements and the paucity of evidence to substantiate them. For

example, a widely publicized study by Harvard—NIMH psychiatrists

(2005), (for which taxpayers paid $20 million) proclaims: " More than

half of Americans will develop a mental illness at some point in

their lives, often beginning in childhood or adolescence. "

Dr. McHugh, former chairman of psychiatry of s Hopkins was

so incensed by this outlandish pronouncement clearly aimed at

expanding psychiatry's domain, he said:

" Pretty soon, we'll have a syndrome for short, fat Irish guys with a

Boston accent, and I'll be mentally ill. " See: Benedict. Carey Most

Will Be Mentally Ill at Some Point, Study Says, NYT, June 7, 2005,

http://www.ahrp.org/infomail/05/06/07.php

Psychiatry doesn't merely make unsupported pronouncements declaring

us all mad: psychiatry throws caution to the wind by promoting the

indiscriminate use of the latest psychotropic interventions by young

and old. A recent Brandeis University analysis of prescribing trends

shows that psychotropic drug prescriptions for under 18 year olds

rose 250% between 1994 and 2001. Of these 25% were not associated

with a diagnosis. Validated evidence from controlled trials has

demonstrated that the drugs prescribed induce severe adverse effects

and new (iatrogenic) illness.

U.S. Children are increasingly being diagnosed with manic depression

(a.k.a. bi-polar disorder) in unprecedented record numbers. Elsewhere

in the world, this diagnosis in children is unheard of. Could it be

that an unprecedented genetic mutation occurred or a major

epidemiological shift in the mental state of U.S. children?

Or could it be that U.S. children's early exposure to psychotropic

drugs has resulted in inducing symptoms of manic depression?

No such evidence exists. However, FDA-approved labels of

antidepressants disclose that the psychoactive drugs prescribed for

children have stimulant effects which include:

mania, agitation, anxiety, irritability, impulsivity, insomnia,

depression, suicidality, and psychosis--symptoms associated with

manic depression (a.k.a. bipolar disorder).

Contact: Vera Hassner Sharav

212-595-8974

veracare@...

http://www.boston.com/yourlife/health/mental/articles/2006/03/06/beyon

d_guesswork?mode=PF

BOSTON GLOBE

Beyond guesswork: Treatments often fail, but new studies might help

doctors find drugs and therapies that work

By , Globe Staff | March 6, 2006

Most mornings, Karl Ackerman felt disappointed that, once again, he

was alive.

A depression that began in 1991 had left him feeling so hopeless

that, for more than a decade, he could scarcely leave the house, let

alone find a job: ''If you do not believe you have any worthwhile

qualities, try going for a job interview, " he said. Eventually, the

weight of Ackerman's despondency ruined his marriage, too.

But nothing doctors tried seemed to help -- not the antidepressants,

not the antipsychotics, not the two types of drugs together. For

nearly 12 years, Ackerman relied on talk therapy to keep him from

becoming suicidal -- until he finally found a drug two years ago that

brought him relief.

''The goal of medicine is to cure things. Unfortunately, that is a

work in progress, " said Ackerman, now 59 and president of the Manic-

Depressive and Depressive Association of Boston.

More than 50 years after psychiatrists began widely dispensing drugs

to treat mental illness, the profession is coming face to face with a

humbling reality: Its treatments often fail, leaving millions of

patients like Ackerman to suffer while doctors search for something

that works. Though more and better drugs and therapies are available

today than ever before, psychiatrists still rely on time-consuming

trial and error in deciding how to use them.

Over the last six months, three unprecedented government-funded

studies of the most common mental illnesses -- depression, bipolar

disorder, and schizophrenia -- have underscored just how far modern

psychiatry is from ''curing " mental illness.

The studies -- large, multipart tests of the best available

treatments -- show that drugs and therapy bring almost no relief to

some patients, while many more achieve only temporary or partial

recovery.

In the most recent study, released in February, researchers found

that some combination of drugs and therapy helped nearly 60 percent

of bipolar disorder patients recover from either deep depression or

bouts of mania. However, within two years, nearly half of the

recovered patients had wide mood swings again, usually slipping into

depression.

''I don't think we should be satisfied, absolutely not, " said Dr. Roy

Perlis of Massachusetts General Hospital, lead author of the first

phase of the bipolar disorder research.

But the three studies, which collectively cost more than $80 million,

are also giving psychologists detailed information to help improve

treatment for conditions that afflict 24 million Americans, including

more than 18 million with major depression each year. No single drug

or therapy will help everyone -- or even the majority -- but the

studies are large enough to identify what types of people benefit

most from each treatment, potentially taking some of the guesswork

out of psychiatry.

For instance, among people with chronic depression, well-educated

women with few other medical complications seem to get the most value

from the antidepressant Celexa. Likewise, patients such as Ackerman,

who suffer from treatment-resistant bipolar disorder, seem to improve

significantly when they take a mood stabilizer called Lamictal, the

drug that ended Ackerman's long period of darkness.

''No one ever felt we could cure mental illness " with current

treatments, said Dr. Freedman, editor of the American Journal

of Psychiatry, which published the initial results of the

studies. ''These are groundbreaking studies for our profession. They

clearly set the bar much higher, and they also are sufficiently

powerful to begin to get meaningful guidance for clinicians. "

Unlike drug company-funded studies, which sometimes produce falsely

encouraging results by focusing on short-term recoveries and avoiding

tough patients, these National Institute of Mental Health studies

followed patients for years and included the most treatment-resistant

cases. Moreover, the patients were treated by their normal doctors

rather than at central locations, more closely simulating real-world

medicine than most clinical trials.

The result, say psychiatrists, is the most realistic look ever at the

state of psychiatric medicine. The picture is not always pretty.

The study of bipolar disorder, the most treatable of the three

illnesses, was actually the most upbeat of the three despite the high

relapse rate. ''There is good reason to be hopeful, but there is lots

of work to be done, " said Mass. General's Perlis, noting that the US

Food and Drug Administration has approved several new drugs for the

disorder in recent years.

By contrast, nearly three-quarters of the schizophrenia patients

stopped taking the drug that was originally assigned to them in the

18-month experiment, mainly because the medications didn't improve

their condition enough or they couldn't stand side effects such as

weight gain or nervous tics. To the researchers' surprise, a little-

used older drug, Trilafon, worked as well as most of the newer drugs

at a fraction of the cost.

''These results should cry out for . . . a whole new generation of

drugs to treat schizophrenia, " Dr. Insel, the NIMH director,

declared at a press briefing last September to announce the results,

the first phase of the schizophrenia study, known by its acronym,

CATIE.

In the study of 4,000 chronically depressed people, only 30 percent

got complete relief from taking an antidepressant similar to Prozac,

and half didn't improve much at all. ''Unfortunately, doing miserably

is common, " said one doctor involved in the depression project,

called STAR*D. The researchers concluded that Prozac-like drugs by

themselves simply aren't enough to end depression for many patients.

Like the other two studies, the researchers did not give up on

patients who did not immediately recover. Future phases of the

depression study will look at treatments for the 70 percent who did

not respond to Celexa, including other drugs as well as cognitive

behavioral therapy, which helps patients manage their condition

through knowledge and self-insight.

Psychiatry has made enormous progress since the early 1950s, when

tens of thousands of mentally ill people were locked in institutions

and sometimes subjected to crude, poorly understood treatments. The

pace of drug development has quickened dramatically in the last 20

years from FDA approval of Prozac in 1987 to a new generation of

antipsychotic drugs that treat schizophrenia without the risk of

neurological damage posed by earlier drugs.

But, until now, doctors have had little guidance on how best to use

the burgeoning number of treatment options. That can frustrate

patients as they go through one treatment after another while in the

grips of deep psychological misery. Even if there is an effective

treatment, they can be forced to wait months or years for relief.

''If you're the person going through it, all you want is relief, and

it's really disheartening to be told you've got to stay on something

for eight to 12 weeks whether it works or not, " said Ackerman.

Federal officials hope to offer, when the studies are finished,

almost a guidebook for doctors on when and how to best use available

treatments and how to know when a patient is truly recovered. In the

bipolar disorder study, for instance, researchers found that the

patients most likely to relapse were the ones who never shook all the

symptoms of depression.

Dr. S. Sachs of Mass. General, lead researcher on the bipolar

disorder project, said he saw improvements in the outcomes for

patients after the psychiatrists in the study underwent training to

help them make the best drug and therapy choices.

''We are not curing people, but we are actually able to manage them

in a way that appears to be reasonably effective, " he said. ''Is the

glass half full or half empty? "

can be reached at allen@....

2005 The New York Times Company

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March 12, 2006