Saturday, August 30, 2008

Depression is a Disease, Right?

Were told mental illnesses are diseases (caused by a specific pathology). Major Depression is the most prevalent of these "diseases." Why can a disease that is supposedly caused by neurological-chemical imbalances be treated effectively with a 50-minute, once-a-week relationship with another person? Biological psychiatry hasn't explained that one yet. In this months Archives of General Psychiatry (1), an article, using the failed STAR*D data, attempted to find predictors of response to second-step antidepressant medication monotherapies. Surely, the results included very precise biological factors, such as the cytokines IL-1?, IL-2?, TNF-alpha?; hyper/hypo cortisolemia?

The researchers concluded, "Clinical, demographic, and treatment history were of little value in recommending 1 medication vs another as a second-step treatment for major depressive disorder. Participants most likely to remit in the second step had less Axis I psychiatric disorder co morbidity, less social disadvantage, and at least a response to citalopram in the first step."

Specifically, those who were more likely to respond were "white, employed, cohabiting or married..." Also included were other specific biological predictors such as, "privately insured," or "no prior suicide attempts," or "who had prior intolerance to citalopram or at least a response to citalopram..."(I don't even know what that last part means). So if you didn't respond to citalopram, you're likely to respond to another medication; if you did respond to citalopram, you're likely to respond to another medication. That's of great predictive value. Luckily there was no placebo control, otherwise these results might actually mean something.

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