Tuesday, June 23, 2009

Successful Depression Treatment as a Side Effect. Ornish’s Heart Health Intervention. AJPH July '09

Successful Depression Treatment as a Side Effect. Ornish’s Heart Health Intervention.

Meds vs. therapy. Therapy wins this one.

American Journal of Public Health is publishing a big, well-conducted study of health behavior interventions for heart disease risk. Not pills to treat the risk of heart disease, but coached, taught behaviors.

“Socioeconomic status and improvements in lifestyle, coronary risk factors, and quality of life: the Multisite Cardiac Lifestyle Intervention Program.” American Journal of Public Health, July 2009.

This comes to us from aptly named heart health physician Dean Ornish, now firmly established as the dean of heart health.

The heart of the matter is that a LIFESTYLE program leads to clinically worthwhile improvement in heart health for people with heart disease.

The lifestyle program, in brief, includes twice-a-week meetings for three months, where staff guide the participants through diet change, beneficial exercise, stress management, and group support focused on these lifestyle changes.

I will skip the heart health outcomes - they will probably be covered in the media pretty well.

Here is the profound outcome that is sure to upset the Pharma-sponsored psychiatrists, and everyone else who believes the serotonin-hypothesis, genetic-hypothesis, “brain disorder,” pills-are-needed-to-cure-it version of depression:

This healthy lifestyle program reduced depression scores. Effect size point five. Impressive!

In other words, without a pill in sight, depression scores got lower as a SIDE EFFECT of a heart health program. A SIDE EFFECT.

Profoundly? Not quite profoundly, but impressively.

Depression can be effectively treated with an intervention developed for lowering cholesterol and lowering blood pressure.

Does this fit the serotonin-hypothesis, genetic-hypothesis, “brain disorder,” pills-are-needed-to-cure-it version of depression?

No.

Possibly, it might, on the extremely small possibility that the promoted 3 grams per day omega-3 fatty acid supplement pill brought about this cure. Unlikely. That is the only pill in sight. Fish oil.

No Prozac, no Zoloft, no citalopram, no escitalopram. And no antipsychotics for depression, God-forbid. No zyprexa, no clozaril, no risperdal.

Take a gander at those pill-based treatments for depression, and figure out their side effects. Do they cause heart health? No. Does the behavioral heart health program have depression reduction as a side effect? Yes.

Pick your poison.

Now, to be fair to those who believe in the “medical model,” disease-model, serotonin-hypothesis, genetic-hypothesis, “brain disorder,” pills-are-needed-to-cure-it, we-need-more-genetics-studies version of depression, the depression levels noted in this study are “subclinical” level. Depression scale scores (on the CES-D, where higher scores indicate greater levels of depression symptoms) above the norm of 8, but mostly below the recognized level of 16, indicating the likelihood that a person scoring at that level would get a diagnosis of depression if given a formal, complete psychological assessment.

But this is worth noting: “subclinical” levels of depression scores, while not as severe as “clinical” depression, IS associated with similar impact on “misery” (by quality-of-life scores) felt from depression, and is associated with similar levels of other bad outcomes such as increased sick-days at work, increased medical care use, increased risk of poor management of diabetes and other health care conditions, increased risk for heart disease, etc.

Also worth noting: one challenge for depression research is achieving “full symptom remission.” Why? For Big Pharma, they want you to ADD another pill. Take TWO pills for depression, not one. So they can SELL twice as many pills. Or so TWO Pharma companies can BOTH make money off of your misery. Medication-based studies of depression treatment lately have been focusing on getting scores reduced from this moderate range down to normal, “I am no longer depressed” range.

If you think about it, it would seem more difficult to drop depression level A LOT for people with moderate, not high, levels of depression. But this study does.

Results are given by education level. Depression scores dropped 20% of a standard deviation (this is a common way - portion of change in terms of the range of “average” scores -- to report change in some outcome that allows you to compare across studies despite varying questionnaires used to measure symptom level) for high-school-or-lower education levels.

For the study participants above the high school education level, scores dropped 50% of a standard deviation.

In plain English, these are very strong results.

These results fly in the face of the serotonin-hypothesis, genetic-hypothesis, “brain disorder,” pills-are-needed-to-cure-it version of depression.

These results strongly support the vast amount of already established literature that psychosocial interventions are a leading treatment for depression.

All of this fits with the psychosocial explanation of depression, and fits with the psychosocial treatments. Various pieces of this heart health treatment are recognized as being depression treatments: in other guises, lots of this stuff is called “exercise intervention,” “behavioral activation,” “interpersonal therapy” AKA “IPT,” stress management, “supportive therapy,” etc.

And depression was just a side-effect of this heart disease intervention.

Other side effects included:
reduced hostility scores.
Reduced stress scores.
Improved “quality of life,” both physical health (broadly) and mental health (broadly).

Now, pay attention to the warning label on the box, and the list of side effects quickly noted in the TV commercials for the pill-based depression treatments. Suicide. Wait: did they just say suicide is a side effect of medication-based depression treatment? I thought suicide was a symptom, not part of the cure. Hey, if you missed the TV commercial, just read the warning label on the package. Or read the package insert. Or check Rxlist.com for “known” side effects of antidepressants. Or check www.ssri-stories.com for a multitude of case reports. Or ask your friends and family who have taken these pills.

Pick your poison.

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