Our Empathic Nature

The Altruistic Side of Evolutionary Psychology

The Myth of "Evidence-Based" Treatment of Depression

Outcome studies of treatment for depression comparing medication to talk therapy are flawed. Using only one class of medication when many depressed people need another, its no wonder medication seems the same or less effective than talk therapy. If you give people the wrong kind of medication, the comparison to talk therapy becomes meaningless. Read More

Federal drug laws interfere with medical practice

I think psychiatrists prefer SSRI because of the fact that many dopamine agonist are controlled substances. Many doctors fear that feds will crack down on their practice because of this. So they make a compromise the psychiatrist prescribes a less effective substance that they hope will work but keeps the government off their back

Maybe

You have a good point --but there are dopaminergic agonists that are not more "controlled" than SSRIs, and if the choices are limited, that poses another question --why hasn't big pharma come up with new dopaminergic agonists? In any case, there is Wellbutrin. I think I'm trying to make a point here --there is something inherently flawed in the "outcome" studies. Our studies using the NAQ certainly indicate that some people (almost 1/3rd of people who demonstrated a problem with depression --by their self-diagnosis as well as their responses on a validated measure of depression) are not going to have a great response to an SSRI, or at least not an SSRI alone. In any case, thanks for your comment, it's an excellent point.

Thank you

Excellent article. I`ve experienced depressive symptoms for decades. I`ve tried both SSRIs and talk therapy and combination therapy. For me the most debilitating feature of my depression is when my cognition declines and my brain seems to get stuck in a cycle of negative thinking,dissociation, and confusion, what I call a brain fog.

What is interesting is that estrogen has had far more positive effect on my depressive symptoms and cognition than any psych medication or talk therapy. I`d like to see more research done on the effects of estrogen on the brain.

In my experience with several

In my experience with several psychiatrists for my chronic depression and inattentive ADD, none of them did a thorough investigation of the type of depression I had (low dopamine vs. low serotonin)and which type of AD would work best. It seems to me that my prescriptions were based on whatever the latest and greatest med that was being promoted in the market place. I either had depression or not and if the medication doesn't work or work very well, I must have some secondary gain. I have thought for quite some time that not all depression is the same, but not many psychiatrists are not aware of this. They just want to figure out which DSM box to put you in.

My symptoms of low energy, low motivation, apathy, inability to concentrate, and general malaise indicate low dopamine depression. However, I have mostly been prescribed SSRI's for the last 20+ years which never worked very well. If I informed my shrinks that they did not seem to be working, making me feel more tired, kind of dull and numb, their only solution was to increase the dosage. It's taken me years to wean myself off SSRI's as the withdrawal effects are pretty bad.

Rather than ask whether a patient is depressed or not which is a very subjective and low threshold for measuring success (like a D grade in school), psychiatrists should ask how a person is functioning in his life and try for an A. That could possibly lead to a better determination of whether a treatment is working or not.

thanks for your comment

Hi anonymous: Your experience is not uncommon, which is one reason we developed a measure (the Neurotransmitter Attributes Questionnaire (NAQ) that seems to somewhat reliably determine what's going on in the serotonergic and the dopaminergic circuits, albeit indirecctly --you seem quite sophisticated (more than some of the psychiatrists you've seen it appears). And you are right, your symptoms sound like they fall on the dopamine trouble side. Some people have dysfunction of both systems, and need agonists for both. Thing is every single person i've ever met is different, and so psychiatrists who are prescribing (I'm a psychologist and we don't prescribe medication in most states) really does have to spend time in initial evaluation, to see what makes sense given a person's symptoms and life functioning. Our measure is published and you can find it at URL: http://sgo.sagepub.com/content/3/2/2158244013492540
so if you see another psychiatrist you can bring him or her a copy, and discuss it, and your prior experience with SSRIs etc. and see if you get more personalize care.

Thanks for your comments.

LynnOC

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Lynn E. O’Connor, Ph.D., is a clinical psychologist, Professor at the Wright Institute, Berkeley CA, and Director of the Emotion, Personality, and Altruism Research Group. more...

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