Respectful Insolence

Two actors and their woo

Why does anyone listen to actors when they pontificate about health and medical issues?

Think about it. What is it that actors do? They read lines given to them. True, some have a talent that goes beyond that; they can actually write or direct. But few of them have any more abilities when it comes to science than the average populace. Indeed, arguably, they have less knowledge of science than average. Witness, for instance, Jenny McCarthy and her crusade against vaccines. Yes, I realize that she claims not to be “antivaccine,” but her actions and words say otherwise. She’s also managed to suck her boyfriend Jim Carrey into the morass of quackery and pseudoscience for which she has become the figurehead.

Except that apparently Jim Carrey was more than receptive to McCarthy’s charms other than her obvious ones:

Carrey – who has long been open about his own battles with depression – says he’s the happiest he’s ever been thanks to vitamin supplements. Too often, he claims, people think anti-depressants are the only answer.

“I think the medical establishment we’re presented with, it’s a system,” said the comedian. “They’re taught a certain thing. There is drug company money that goes into the educational system. I’m saying you have to look outside that, and consider the other possibilities for people.”

In the end, he said, “It’s important that there are alternatives.”

Carrey made similar comments to CNN’s Larry King on Monday night, wading into potentially controversial territory. Most notably, he said he “didn’t disagree” with Tom Cruise’s infamous condemnations of prescription medications.

Yes, indeed. There’s big pharma conspiracy mongering yet again, and, worse, he appears to be going straight into Scientology country:

“I think Prozac and things like that are very valuable to people for short periods of time,” he said on the show. “But I believe if you’re on them for an extended period of time, you never get to the problem.”

Note the false dichotomy: Either people are on antidepressants for a long period of time or we “get to the root of the problem.” Of course, the “root of the problem” is biochemistry. The drugs are an imperfect correction for the abnormalities in brain biochemistry that result in depression, but it is generally agreed that those alterations are the “root of the problem.” One wonders what Carrey thinks to be the “true” cause of his depression. Whatever he does think (if you can call it thinking), though, it’s not surprising that he had an affinity to Jenny McCarthy and her “Indigo child” woo and her belief that vaccines made her son autistic.

Speaking of vaccines and autism, one of the concepts behind the belief that vaccines somehow cause autism is that it is the mercury in the thimerosal preservative that used to be in many childhood vaccines until 2001 that causes autism. Alright, alright, I know it’s a lame segue, but, speaking of mercury “poisoning,” witness Jeremy Pivens, who bowed out of a production of Speed the Plow for a rather unusual reason:

But on Wednesday night, Mr. Piven’s publicist, Samantha Mast, wrote in an e-mail message that he was not feeling well, and that “his doctors have advised him that he should end his run immediately.” She referred questions about Mr. Piven’s diagnosis to his physician, Dr. Carlon M. Colker, the medical director of the Peak Wellness clinic in Greenwich, Conn., and a diet book author who has worked with clients like Andre Agassi and the snowboarder Chris Klug.

In a telephone interview on Thursday, Dr. Colker said that Mr. Piven had come to him soon after the show had opened, complaining of excessive fatigue and exhaustion. Noting Mr. Piven’s artistic lineage — his parents founded the Piven Theater Workshop near Chicago — Dr. Colker said, “For him, he’s used to the rigors of an acting career, so he knows the ropes.”

Dr. Colker said that an initial battery of tests on Mr. Piven had shown normal results. But after Mr. Piven said he was a frequent sushi eater who consumed fish about twice a day, and that he used herbal remedies, Dr. Colker tested him for heavy metals.

Dr. Colker said that these tests revealed “a very, very elevated level of mercury” in Mr. Piven’s blood, adding that it was five to six times the upper limit that is typically measured. Left untreated, Dr. Colker said, the condition could result in heart problems, cognitive problems, renal failure and, in very extreme cases, death. He said that he told Mr. Piven he could continue in the show, but only with extreme caution.

Interesting that it’s being blamed on excess intake of sushi when Pivens is known to take various herbal remedies, and Chinese herbal remedies have been found time and time again to be contaminated with various heavy metals including mercury. Dr. Colker is quick to dismiss the possibility that herbal remedies might have contributed significantly to Pivens’ mercury toxicity, assuming he actually was suffering from mercury toxicity. Perhaps it’s because Dr. Colker is a bit of a booster of woo himself. He’s the President and Owner of Peak Wellness and a huge advocate of supplements for bodybuilding and what he calls “general wellness.” He strikes me as a physician to the stars in the same way that Dr. Jay Gordon is a pediatrician to the children of the stars. One also wonders why he so quickly zeroed in on a diagnosis of mercury toxicity. It seems awfully–shall we say?–convenient.

Leave it to David Mamet, though, to sum up the situation drolly:

At least one person associated with the play seemed less forgiving about Mr. Piven’s departure. Speaking to Daily Variety, Mr. Mamet said, “My understanding is that he is leaving show business to pursue a career as a thermometer.”

Heh.

In any case, I present these two examples not to make fun of them (well, maybe a little), but to use them to illustrate the principle of the general cluelessness of actors when it comes to medicine. They fall under the sway of woo-meisters; they do stupid things; they think they know more than real experts. Whether they are more credulous than the general population is difficult, if not impossible, to determine. What is clear is that they have access to the media. When they say and do stupid things, they have far more influence than if you or I said and did stupid things.

Comments

  1. #1 Bob O'H
    December 22, 2008

    Ah, no answer to the big question – why wasn’t Jeremy Pivens given chelation therapy?

  2. #2 bobh
    December 22, 2008

    Your critique of Mr. Carrey’s comments on Prozac and depression seem to indicate that you believe that only through chemistry can we live better. There is certainly anecdotal evidence that this isn’t true – I have gone through two periods of depression in my life. I took no chemicals to deal with them. The worst instance was resolved with time and group therapy – dealing with others who had similar issues was extremely effective in my case. It strikes me as very arrogant to imply that because there is a biochemical cause for most, or even all, depression that the only route to deal with it is with chemicals. In my case there were circumstances in my life that led to depression. The bodies feedback mechanisms, I suggest, are not well enough understood to make claims of certainty with regard to the best way to deal with depression in any single case.

  3. #3 Tsu Dho Nimh
    December 22, 2008

    Bob – If he stops the intake, his body may clear it fast enough to not require chelation.

  4. #4 Mark Westbrook
    December 22, 2008

    I wouldn’t listen to actors talking about acting, let alone anything medical. Actors are incapable of expressing themselves on the topic of acting because they have gained unconscious competence, whereas asking them about medical issues, is just foolish.

  5. #5 Dangerous Bacon
    December 22, 2008

    “Your critique of Mr. Carrey’s comments on Prozac and depression seem to indicate that you believe that only through chemistry can we live better.”

    I didn’t get that impression at all – Orac’s point was Carrey’s ignorance of biochemical bases of depression, evinced by his dismissal of Prozac and embrace of “vitamin supplements” for happiness.

    As to Pivens’ case, there have been reports of high mercury content in sushi, to the extent that eating six pieces a week would put you over EPA “safe” limits.

    http://www.nytimes.com/2008/01/23/dining/23sushi.html

    I would also like to know exactly what “herbal remedies” Pivens was consuming (particularly if any were Chinese-made and/or Ayurvedic). The other big question is whether any elevated mercury levels are actually making him sick or are a convenient target of blame.

  6. #6 Joseph C.
    December 22, 2008

    Your critique of Mr. Carrey’s comments on Prozac and depression seem to indicate that you believe that only through chemistry can we live better.

    You’re beating a very pathetic straw man there. Orac never said that. In fact, he hedged by describing psychiatric drugs as “an imperfect correction”.

  7. #7 Sigmund
    December 22, 2008

    Dr Coker doesn’t exactly show much of a sense of humor regarding Mamet’s joke.
    Comments like Mamet’s, he continued, “reflect a profound lack of understanding of a problem that can actually kill.”
    Can sushi really put you “five to six times the upper limit that is typically measured”?

  8. #8 Orac
    December 22, 2008

    You’re beating a very pathetic straw man there. Orac never said that. In fact, he hedged by describing psychiatric drugs as “an imperfect correction”.

    Indeed. He’s also ignoring the fact that one key aspect of the psychiatry denialist movement most famously represented by the Church of Scientology is the denial that there even is such a thing as mental disease, much less that there is a biochemical basis for it. The attitude behind such denialism seems to be that (1) “mental illness” is just part of the normal spectrum of human behavior that those evil, fascistic doctors are trying to label as “disease” and (2) people can overcome mental illnesses such as depression or schizophrenia by, in essence, force of will alone using various talking and behavioral therapies. Sometimes talking and behavioral therapies (sometimes mixed in with supplements and dietary woo) can be useful, but in the case of a serious, profound depression no amount of talking or behavioral therapy, much less supplements, will allow that person to “shake off” the depression.

    Yes, it’s true that psychiatry has been abused at times, but such abuses do not change the science that a lot of mental illness is biochemically-based and can be–to an extent that can vary from fantastically good to just so-so–corrected with medication.

  9. #9 Marilyn Mann
    December 22, 2008

    “Sometimes talking and behavioral therapies . . . can be useful, but in the case of a serious, profound depression no amount of talking or behavioral therapy, much less supplements, will allow that person to ‘shake off’ the depression.”

    I certainly am not advocating treating depression with supplements, but I would hesitate to go so far as to say that major depression can never be successfully treated with therapy. I’m not saying that because I’m against antidepressants — I’m not — I just think therapy can work in some cases also.

    “Yes, it’s true that psychiatry has been abused at times, but such abuses do not change the science that a lot of mental illness is biochemically-based and can be–to an extent that can vary from fantastically good to just so-so–corrected with medication.”

    Agree, except that there are some unfortunate people, including people with major depression or schizophrenia, who are not helped by medication at all. To me “so-so” implies some degree of benefit, and for some people that is unfortunately not the case. The solution is to develop better medications.

  10. #10 AnnR
    December 22, 2008

    I’m sure there are some smart actors/actresses. But I don’t think that Hollywood is a place that puts a lot of value on “book” learning. I’m always amazed when I read interviews with actors acting in famous works of literature and they haven’t read the original story. That would be the first thing I’d want to do!

    Anyway, they get out there and get famous and forget that while they may have a good memory and a pretty face, comic timing, the ability to cry on demand, they aren’t generally anything close to a rocket scientist.

    I for one don’t take anything they say seriously!

  11. #11 Orac
    December 22, 2008

    I certainly am not advocating treating depression with supplements, but I would hesitate to go so far as to say that major depression can never be successfully treated with therapy. I’m not saying that because I’m against antidepressants — I’m not — I just think therapy can work in some cases also.

    Evidence?

    I’m not saying you’re incorrect, but I have yet to see any convincing evidence to support this the point of view that a major non-reactive depression can be treated successfully without antidepressants.

  12. #12 Marilyn Mann
    December 22, 2008

    Orac, I’ll see what I can dig up.

  13. #13 BAllanJ
    December 22, 2008

    OK…well, actors deal with anecdote, not data.

    Here’s my anecdote:

    I had a years long depression going a while back. By “force of will” I was able to mostly function normally… built a wall around myself so no one knew how I was inside. So from the point of view of the world, I guess force of will can work. I lived alone, so the odd time that I sat at home crying instead of going to work were hidden. I made contracts with myself to delay killing myself. Sometimes I even could live outside that wall for a bit and think it was finally over. Not for too many days in a row, though.

    Best thing I did to end it was breaking down at my annual physical and get onto some SSRIs for a few months. Took a couple of months to feel fully functional again, then I stayed on them a couple more months. When I weaned off them (with advice from my GP)I felt even better. That was a couple years ago.

    Too bad I went so long building my wall… and I’m still not entirely clear whether the end of my marriage was a cause or an effect, but… life goes on… now anyway.

  14. #14 The Perky Skeptic
    December 22, 2008

    Must not rant… must not rant… must not rant…

    I went to a therapist for a full year who never identified my bipolar disorder!!! Surprise, surprise, I was still having the same mysterious mood issues fifteen years later! My psychiatrist talked to me for literally FIVE MINUTES before looking at me in shock that no one had ever before identified me as bipolar. Antidepressants and mood stabilizers are allowing me to live a normal life, AAAAAAAAAAGH!!!!!

    :relurks:

  15. #15 Lucario
    December 22, 2008

    Six pieces of sushi a week. Man, I sometimes eat 3, 4, sometimes even 5 times that many at your typical sushi buffet. I’ve never had any fatigue or emotional problems afterward, and I’m not even sure how I could tell my kidneys were damaged. Why is it that I’m ingesting so much mercury (and not knowing it), but I’m not getting sick?

  16. #16 Dianne
    December 22, 2008

    I have yet to see any convincing evidence to support this the point of view that a major non-reactive depression can be treated successfully without antidepressants.

    ECT. It’s not pretty but it works reasonably well. One could debate whether and when the side effects are worth it, of course.

  17. #17 Karl Withakay
    December 22, 2008

    There are certain types of depression where there is no significant psychological basis for the depression, and no amount of psychological intervention alone can “pull the depressed person out of their funk”. I bleive those are some of the depression cases of which Orac is speaking.

    In cases of major clinical depression, drugs and therapy are complimentary, and usually are most effective when used together. Is it possible to treat major clinical depression with only one or the other? Yes sometimes, but probably not as effectively. Why try to tie you shoe with only one hand if you have two effective hands to use?

    To those who have “worked through” past depressions w/o chemical intervention I give my honest congratulations with a few caveats. First, past performance is no guarantee of future returns. Also, how long did it take you to work out your depression? If it was fairly quick, kudos, but consider the possibility that you may have been able to work through your depression faster or more easily with some support from antidepressants.

    Also, many of us believe we have gone through a depression in our lives, but probably haven’t experienced a true, major clinical depression. There’s a world of difference between a major funk or a really rough patch and a true major clinical depression.

    (I am not a doctor, so I’m perfectly willing to be corrected by an expert who know better than I on anything I said here.)

  18. #18 Karl Withakay
    December 22, 2008

    ECT is still a medical intervention beyond psychological therapy. It’s actually more radical than drugs and is usually only used when chemical interventions have failed.

    I took Orac’s point to be that there are cases when psychological therapy is ineffective by itself.

    Additionally, while I don’t believe the exact mechanism through which ECT works is clearly understood, but I believe it’s generally understood to affect brain chemistry in some way, and thus could be considered “drug-like in that regard.

  19. #19 Sanity Jane
    December 22, 2008

    Mr. Carrey’s ill-informed comments about antidepressants notwithstanding, I wouldn’t be too quick to sneer at his supplement therapy. After all, nutrition has a fundamental effect on body chemistry, and depression is a documented consequence of some nutritional deficiencies.

    I’ve lived with depression since puberty. During episodic bouts of severe depression and anxiety at a time of crushing job stress, my doctor prescribed Xanax, then Prozac. I was on each of them for weeks with no discernible improvement. I also tried therapy (even though I had a previous bad experience with it), but all the therapist wanted to talk about was how religion had helped her through her own problems.

    I was resolving myself to suicide when I had an epiphany: my blackest episodes were always pre-menstrual. I bought a couple of books on managing PMS and on their advice started taking supplements (B-complex, calcium, magnesium, selenium). I do not exaggerate when I say that those supplements saved my life.

    When I told my doctor that I had PMS, she squinted at me and asked, “Who diagnosed you?” Having wasted months and come close to ruining my life, if not actually ending it, I was tempted to say, “Not you, you incompetent twit.” This same doctor tried to prescribe antibiotics for a severe cold when all I wanted was something to relieve an incapacitating cough and help me get back to work. I had to explain antibiotic resistance to her. (I’m a biologist who self-diagnoses, self-treats, questions diagnoses and treatments, and complains about being kept waiting. Doctors hate me.)

    So, no, I don’t take medical advice from celebrities, but I also don’t buy into the idea that doctors and prescription drugs are the be-all and end-all as far as my mental and physical health are concerned.

  20. #20 bobh
    December 22, 2008

    Orac: “He’s also ignoring the fact that one key aspect of the psychiatry denialist movement most famously represented by the Church of Scientology is the denial…”

    I’m not ignoring anything about Scientology. I wasn’t addressing it or them. I was addressing you and what you said. No straw man here:

    “Of course, the “root of the problem” is biochemistry. The drugs are an imperfect correction for the abnormalities in brain biochemistry that result in depression, but it is generally agreed that those alterations are the “root of the problem.””

    The true root of the problem is what caused the bio-chemical abnormalities in the first place. What causes the bio-chemical abnormality that leads to bipolar disorder? At best our current knowledge of this allows us to treat the symptoms. In my case I believe my clinical depression was caused by life experiences – learning how to deal with those and accept them removed the depression (willing the depression away had nothing to do with it). That would mean, if the depression was ’caused’ by biochemical abnormalities, then the therapy also changed those abnormalities

    By the way I wouldn’t question the veracity of anyone who found that their depression was helped by Prozac. I am certainly willing to accept that not all cases of depression are the same as mine. I would expect the same courtesy from others.

  21. #21 Julian
    December 22, 2008

    Bah! All people ever want to do is talk about how they feel. Glad I’m cynical and single. If I ever had to deal with some idiot that wouldn’t take medication for a problem…I’d probably push them over the edge. Um…I guess it’s something we should all be thankful for.

    A quick note on everyone’s anecdotes. No one cares about your lives. Learn to live with it. :)

  22. #22 Sanity Jane
    December 22, 2008

    Glad I’m cynical and single.

    Good thing, too, because that second part’s not likely to change.

    Now STFU and take your meds.

  23. #23 synapse
    December 22, 2008

    “Also, many of us believe we have gone through a depression in our lives, but probably haven’t experienced a true, major clinical depression. There’s a world of difference between a major funk or a really rough patch and a true major clinical depression.”

    I wonder which one Jim Carrey had. After all, if he was in a rough patch because, for example, he was always acting in crappy movies, therapy or exercise might have been more beneficial for him that the antidepressants, especially if he suffered bad side effects. I spent high school and college being mildly depressed and suicidal, and when I finally tried antidepressants, I found I couldn’t sleep more than 2 hours a night on the Celexa (oh god that sucked) and 5 or 6 a night on the bupropion. Even though the bupropion made me really happy, I couldn’t take the lack of sleep.

  24. #24 Dianne
    December 22, 2008

    Additionally, while I don’t believe the exact mechanism through which ECT works is clearly understood, but I believe it’s generally understood to affect brain chemistry in some way, and thus could be considered “drug-like in that regard.

    Psychotherapy, if it is effective, must also affect brain chemistry in some way. In fact, psychotherapy does change brain chemistry, suggesting that it is at least partially effective. Or at least is having some effect, if not necessarily the same effect as drug therapy.

  25. #25 Julian
    December 22, 2008

    Good thing, too, because that second part’s not likely to change.

    Now STFU and take your meds.

    That’s self-imposed. I swear!

    <_ <
    >_>

  26. #26 Karl Withakay
    December 22, 2008

    With all the discussion of medication vs therapy, I’m surprised that is hasn’t lead to a debate between the “The mind is a result of brain function” vs the “The brain is a receptor for the mind” camps.

    I thought we’d have to bring in Steven Novella by now.

  27. #27 Dianne
    December 22, 2008

    Gah! Apologies for the formatting failure above. Orac, can this be fixed?

  28. #28 Karl Withakay
    December 22, 2008

    Dianne,
    I still maintain that trying to treat a major clinical depression without medication is usually going to be like trying to tie your shoes with only one hand; you’re making it more difficult than it needs to be, and you have a lower chance of success.

    [/end weak argument by analogy]

  29. #29 DonZilla
    December 22, 2008

    Why does anyone listen to actors when they pontificate about health and medical issues?

    This is America. We elect actors for President.

  30. #30 Skeptyk
    December 22, 2008

    Pivens’ doc sez: “a very, very elevated level of mercury” in Mr. Piven’s blood, adding that it was five to six times the upper limit that is typically measured…

    And what, exactly, does this mean in real health terms? I can have 5 or 6 or 90 times the “upper limit that is typically measured” of any number of things and still be just fine. Dose makes the poison.

    Also, I am wanting to know what lab he uses. Could it be Great Lakes or one of the other labs so beloved of quacks, with their teeny, narrow band of normal values, by which reckoning many more folks can be diagnosed as hyper-whatever and “toxic” and in need of the pill-pushing of an “orthomolecular medicine” maverick?

  31. #31 Michael X
    December 22, 2008

    I see you don’t have a large readership of actors. Nevertheless, lets not jump on the actor bashing bandwagon here. For a group of people who understand the idea sample sizes, it seems that it takes very few examples before you proclaim that actors know next to nothing.

    Keep in mind the actors you know are famous ones. And famous actors make up about .0001 percent of the acting population. Furthermore, a goodly number of woo soaked doctors like Piven’s also exist (ScienceBasedMedicine is a good place to find them), but that doesn’t bring anyone to pontificate about how doctors shouldn’t be listened to.
    Artists may not on average be as analytical as most scientists, but that doesn’t mean as a whole they arn’t, in much the same way that scientists may not, on average, be the most animated or dramatic people, but that doesn’t make them emotionless droids.

    So lets rephrase this into a reasonable statement that is more in line with the caliber of this blog: “Non-experts should not be given more respect than their understanding deserves.” This goes for rock-stars, athletes, actors, pundits, writers, blogger, scientists and engineers talking about biology.

    And yes, Jenny McCarthy should be ignored, just like Piven’s Doctor.

  32. #32 Dangerous Bacon
    December 22, 2008

    If we’re going to listen to celebrities on effective treatments for mental illness, I’d much rather go with the Ramones:

    Psycho Therapy
    Psycho Therapy
    Psycho Therapy
    That’s what they wanna give me
    Psycho Therapy
    Psycho Therapy
    Psycho Therapy
    All they wanna give me

    I like takin’ Tuinal
    It keeps me edgy and mean
    I am a teenage schizoid
    I am a teenage dope fiend

    from “Psycho Therapy”

    Obviously this reflects a belief in biochemical solutions.

  33. #33 The Perky Skeptic
    December 22, 2008

    Michael X said:
    “So lets rephrase this into a reasonable statement that is more in line with the caliber of this blog: “Non-experts should not be given more respect than their understanding deserves.””

    I thought that was pretty much what Orac said, in his Respectfully Insolent(TM) manner.

  34. #34 Michael X
    December 22, 2008

    No, Orac included in his comment some noise about actors generally knowing nothing. The revision was free of such slips of frustration.

  35. #35 Dr X
    December 22, 2008

    Quote of the week:

    She’s also managed to suck her boyfriend Jim Carrey into the morass of quackery and pseudoscience.

  36. #36 DrCogSci
    December 23, 2008

    Hi all,

    The psychotherapy and anti-depressant conversation is one I started looking into when a friend of mine was diagnosed with depression. The anti-depressants seem to be helping, but I was amazed by the incredibly vague diagnostic criteria for depression. I don’t deny the existence of mental illness, but it occurs to me that it would be very easy to over-diagnose it, especially with cases of mild to moderate depression.

    Particularly, (and although I am loathe to use anecdote) my friend was diagnosed with depression and put onto an SSRI after a single consultation with a GP. Without making light of his discomfort, I am not certain that this is a sufficiently rigorous examination before commiting to a medication which takes 4 – 6 weeks to “work” and requires a 6 month weaning period to leave.

    The percieved effect of the medication started long before the 4 week mark, which I would contend is consistent with a placebo effect (of course, this is not to say that it didn’t have a non-placebo effect thereafter).

    From what I have read, there is some evidence to suggest that cognitive therapies are as effective as anti-depressants, that the serotonin deficiency that SSRI’s are supposed to correct is not as well-supported as one would believe from their popularity, that over-diagnosis is a serious possibilty, that the DSM can be too vague for meaningful diagnosis in every case and that there may be some long-term sexual side effects from having *ever* been on an SSRI.

    I apologise sincerely if that sounded like a Gish Gallop, I am trying to condense a lot of varied reading into a post. I guess the real question is, how sceptical can one be of depression diagnosis and treatment, without falling into the trap of denial, and are the things I have mentioned legitimate questions, or do they arise from the misunderstandings of a lay-person?

    Finally, if anyone would like references etc. I can provide them once I’m at my home PC. Apologies again for the long post, I’m hoping to get some more informed opinions than my own on the subject.

    (in before TL;DR)

  37. #37 Marilyn Mann
    December 23, 2008

    This is a response to Orac’s comment at 10:44 yesterday. I found the following study that seems to support efficacy of cognitive behavior therapy in at least some cases of major depression.

    DeRubeis et al., Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression, Arch Gen Psychiatry. 2005;62:409-416.

    http://archpsyc.ama-assn.org/cgi/content/abstract/62/4/409

    Hollen et al., Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression, Arch Gen Psychiatry. 2005;62:417-422.

    http://archpsyc.ama-assn.org/cgi/content/abstract/62/4/417

    The following study is also interesting:

    Kennedy et al., Differences in Brain Glucose Metabolism Between Responders to CBT and Venlafaxine in a 16-Week Randomized Controlled Trial, Am J Psychiatry 164:778-788, May 2007.

    http://ajp.psychiatryonline.org/cgi/content/abstract/164/5/778

  38. #38 Orac
    December 23, 2008

    You missed a more recent review:

    http://www.nature.com/nrn/journal/v9/n10/full/nrn2345.html

    Apparently cognitive therapy depends very much on the skill of the practitioner.

  39. #39 Marilyn Mann
    December 23, 2008

    Thanks for the tip. I’ll take a look.

  40. #40 Dave
    December 23, 2008

    SSRIs require a 6 month weaning off period? News to me!

  41. #41 DrCogSci
    December 23, 2008

    My apologies for the “6 month” claim. One of the sources I was thinking of is this pamphlet for Wellbutrin. (4 – 9 months) though this isn’t an SSRI.

    http://www.sasop.co.za/images/F_personDepression.pdf

    I have seen varying claims for the weaning off of SSRI’s, from 3 weeks to several months, at varying locations.

    The DeRubeis and Hollon papers were the Cognitive Therapies I was referring to earlier. Irving Kirsch is the other notable name I was lacking in my previous post. As in:

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=558707&tool=pmcentrez

    amongst others. There is a great audio debate called “The Drugs Don’t Work” which raised a number of questions for me. Also, a debate in the BMJ on over-diagnosis of depression also didn’t seem to be soundly won by the “no” position.

    http://www.bmj.com/cgi/content/full/335/7615/328 (Yes)

    http://www.bmj.com/cgi/content/full/335/7615/329 (No)

    Ben Goldacre’s column contains a bunch of good stuff, some of which – like “the Medicalisation of Everyday Life”
    (http://www.badscience.net/2008/09/the-medicalisation-of-everyday-life/) – speaks to the claim that certain syndromes etc. may be over-diagnosed. Though the teleology behind such starts to look a little conspiratorial for my liking.

    I thus remain paralysed by fear of denying a very real source of suffering, but being sceptical of a great deal of the material in the literature. Any ideas on what I should do about it? :)

  42. #42 QrazyQat
    December 24, 2008

    As to Pivens’ case, there have been reports of high mercury content in sushi, to the extent that eating six pieces a week would put you over EPA “safe” limits.

    Note that the NYT issued a correction for their article and pointed out that the EPA had actually said that 6 pieces of tuna sushi per day for several months would exceed their suggested safe dose. That’s a lot of sushi, and of course refers only to tuna sushi. It seems to me that to then get yourself to “5 or 6 times” the safe level woul dtake one hell of a lot of tuna sushi eating each and every day for months on end. Kinda seems unlikely to me.

  43. #43 Alison
    December 25, 2008

    Medication for things like depression is still kind of hit-or-miss, since there’s still no definitive understanding of all the intricacies of brain chemistry. However, I do know that the effectiveness of treatment, both psychological and psychiatric, depends upon the skill of the practitioner. After a long time taking moderately effective medications, I found a psychiatrist who took care to evaluate patients’ symptoms to better determine whether they were more likely related to serotonin, norepinephrine, or dopamine, and choose a medication that would be most likely to affect that specific neurotransmitter. I also learned that my previous doc, in addition to trying a number of completely ineffective medications one after another, had given me a combination at one point that might have killed me if it hadn’t made me feel so awful I stopped it first. If a licensed psychiatrist like my first one had so little understanding of the medications he was dispensing, it’s not hard to imagine a GP making similar mistakes.

    As well, I went through a number of therapists, some more effective than others. None of them did me any harm, but I know people who’ve come out worse from therapy than they went in. Granted, the best therapist in the world could give a patient advice that ends up being used in the wrong way, but a good match between doctor and patient makes a world of difference. Almost 30 years after my first sessions ever, I happened upon someone who has made the most positive impact on my life precisely because of the match between his skills and my needs, just as the medications and dosages I’m currently prescribed match my symptoms.

    It’s not a yes/no, on/off, either/or question, but a complex evaluation of symptoms and treatments that are specific to the patient. Right now, nobody can say that mental condition A can be fixed with treatment B, because the cause behind the symptoms is not yet an absolute. People who state with authority that depression can be treated with vitamins, or with Prozac, or with therapy, have a limited understanding of the entire scope of mental illness and treatments. This places them in a vulnerable position where they can be fleeced by alternative practitioners who take advantage of this kind of ignorance (of scope). It also really irritates people who’ve found an effective therapy for a very real problem and know that it’s not that simple.

  44. #44 DrCogSci
    December 25, 2008

    This post is predominantly @ Alison, but I would appreciate any comments etc. by those who know this field better than I do.

    Even if the effects of cognitive therapy are highly dependent on the skill of the practitioner, there’s a damn-sight smaller chance of your therapist killing you when he’s not prescribing anything. (viz. your comment regarding drug combinations) Hence my reluctance to accept that medication should be so prominent a treatment for an illness which does exhibit the problems of being underspecified, overdiagnosed and not accurately treatable. (as attested to by your 30 years of experience)

    Also, when we’re talking beyond the level of “for this individual” we can state with authority that depression can be (effectively, which I assume was implied) treated with anti-depressants and cognitive therapy. We can’t guarantee success in all cases, but generally speaking, we do know that these things are effective in the treatment of depression from the literature which supports them, hence their availiabilty and adoption by mainstream medicine.

    I don’t believe I’ve oversimplified the question to “yes/no” or “either/or” as you have characterised it. The parts of my post dealing with such clear distinctions were about a debate regarding the overdiagnosis of depression, not the correct treatment methods thereof.

    The underlying assumptions of treatment by anti-depressants seem to still be questionable, despite their efficacy, and I am having trouble finding studies comparing them to other psychoactive (but not inhibatory to SERT, DAT or NAT) compounds, in my cursory looks on PubMed. As a control, are there any studies that anyone else knows of that compare other psychoactive compounds with SSRI’s and the like?

    Lastly, my argument is that over-diagnosis of depression, or over-prescription of anti-depressants, makes the human cost in side-effects much higher if anti-depressants are not considered secondary to therapy as the initial care for patients suspected of depression. Furthermore, therapy – whilst also potentially treating the depression – may also provide a more complete picture of the patient’s mental health, which would make the prescription of drugs safer, and reduce the collateral damage to those who may have recovered without them.

    Granted, we do not know with perfect, or indeed great, accuracy what intervention will work for each individual case, but it seems prudent to hold back on those therapies which stand to do the most damage, if they have no immediate or obvious advantage over others.

  45. #45 Eli Rabett
    December 25, 2008

    Ronald Reagan

  46. #46 DrCogSci
    December 26, 2008

    Now, what was I talking about again?

  47. #47 Alison
    December 26, 2008

    DrCogSci, my comments were not directed specifically to you, and in truth, I agree with you as far as taking a moderate course at first. My history with medications was preceded by many years of therapy. I used to be someone who wouldn’t even take aspirin for a headache, but I had reached a point at which something had to be done, urgently.

    Clearly, conditions are being overdiagnosed, medications are being overprescribed, and people are far too accepting of the idea that a pill can cure their problems. I find this objectionable as well, because it makes it seem like people who have genuine problems are just a bunch of whiners. Under ideal conditions, psychological problems and mental illnesses would be diagnosed and treated by mental health professionals only, and patients would be encouraged to start with the least invasive treatment first, and work up by steps. Patients who ended up using medications would also be given access to talk therapy, since meds without therapy is just a band-aid solution. If this were the case, pharmaceutical treatment wouldn’t be taken as such a joke, and people who needed it might not avoid it.

  48. #48 DrCogSci
    December 26, 2008

    Amen. :) I’m glad I’m at least not WAY out in left field.

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