Monday, March 23, 2009

Recent news, on both the meds and therapy sides. Therapy wins. Meds wins the press release competition.

Two very significant stories about how to effectively treat depression just emerged. Therapy wins this one. Big time. Meds are left with mere speculation. Nonetheless, inspired by visions of huge Pharma paychecks, predictably, there were plenty of Pharma spokesmodels willing to get out in front of the media and declare how great meds are for treating depression.


On the therapy side, some great news: well-conducted cognitive therapy leads to impressive sustained benefit. These long-term outcome results have just been published in one of psychology's leading journals, "JCCP;" the Journal of Consulting and Clincal Psychology.

Vittengl, Jeffrey R.; Clark, Lee Anna; Jarrett, Robin B.
Continuation-phase cognitive therapy's effects on remission and recovery from depression. Journal of Consulting and Clinical Psychology. Vol 77(2), Apr 2009, 367-371.

http://psycnet.apa.org/journals/ccp/77/2/367/

For people diagnosed with major depressive disorder who successfully responded to cognitive therapy in the short term, maintenance of remission at 18 months was strong. The control group, with no continuing cognitive therapy but only assessment across time, did OK – actually did better than a lot of samples from long-term med trials.

This indicates, yet again, that cognitive therapy works for major depression, and indicates that treatment gains are maintained after discontinuation, and rates of remission can be sustained with continued treatment.

Side effects? Uh, like, they were not assessed since talk therapy does not lead to suicide, homicide, dry mouth, erectile dysfunction, jitteriness, or ringing in the ears (except for those familiar ringing echoes of your therapist’s voice).

But you did not hear about this in the news anywhere.

At the same time, yet another SSRI med, received approval for short-term efficacy for adolescents with depression. Great news – for Forest laboratories, and all of the docs getting favors for being compliant with big pharma’s promotion-therapy.

And this has received news coverage.

http://www.docguide.com/news/content.nsf/news/852571020057CCF68525757F0067B7C3

http://www.medicalnewstoday.com/articles/143167.php

http://news.yahoo.com/s/hsn/20090320/hl_hsn/lexaproapprovedforadolescentdepression

Et cetera.

Now, it might occur to you to ask whether escitalopram might work for the long term.

Well, somehow the FDA is able to discern this answer: press release info declares: “Although maintenance efficacy in adolescent patients has not been systematically evaluated, the FDA in its review concluded that maintenance efficacy can be extrapolated from adult data along with comparisons of escitalopram pharmacokinetic parameters in adults and adolescent patients.”

What?

And they can’t discern that a majority of the benefit from escitalopram is placebo effect?

I will have to get hold of this FDA info and look it over.

No worries in the meantime. The press release info notes that Escitalopram is “well tolerated.” If it is as well tolerated in adolescents as in adults, that is not a good thing. At some other time, I will pull out the escitalopram side effect data and I will blog on what “well-tolerated” means. Short story: suicide, aggression, and more.

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