quote:

Originally posted by Slylee all doctors do that, not just shrinks. i have very little respect for doctors these days. they're merely puppets for the pharmaceutical industry. it's sad.

lol

___________________
"You won a new refrigerator, great! Where you gonna put it?" - Tony Danza

For adults with mild to moderate depression, there is no direct evidence that drug or nondrug therapy is superior. Prescription antidepressants are effective at all levels of severity, but systematic reviews have shown no differences in outcomes between any classes of antidepressants.4 Different types of psychotherapy (including cognitive therapy and interpersonal psychotherapy) are also effective for managing mild to moderate depression.1 However, consistent evidence is lacking to make a statement about the relative effectiveness of different types of psychotherapies compared with each other or with drug treatment. One RCT5 comparing nefazodone (Serzone, removed from the U.S. market in May 2004 because of hepatotoxicity) with cognitive behavioral therapy over a 12-week period demonstrated similar effectiveness for each treatment alone. Another RCT6 of 240 outpatients with moderate to severe depression compared the effectiveness of paroxetine (Paxil) and other medications with cognitive behavioral therapy. Both treatment types were found to be effective, but the degree of effectiveness for cognitive behavioral therapy was dependent on therapist experience, and the overall number of patients in the therapy group was small (n = 60).6

An evidence report4 from the Agency for Healthcare Research and Quality states that data are too limited to determine if newer antidepressants are more or less effective than psychosocial therapies. Options for pharmacologic and psychotherapeutic treatment of resistant depression (i.e., depression that has not remitted after a first-line drug therapy) are the subject of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial,2 with results expected in 2006.

Recommendations from Others

The Institute for Clinical Systems Improvement states in an evidence-based guideline that mild to moderate depression can be treated with psychotherapy instead of, or in addition to, pharmacotherapy.7 The guideline also states that cognitive behavioral therapy, interpersonal therapy, and antidepressant medications are equally effective in treating mild to moderate levels of major depression.7 The Veterans Health Administration clinical practice guideline states that psychotherapy generally is an appropriate treatment for all forms of depression managed in the primary care setting, and that because there are no demonstrated differences in treatment outcomes between pharmacotherapy and psychotherapy, patient choice should be strongly considered in treatment planning.8

Clinical Commentary

The appropriate treatment of depression is of special interest to primary care physicians, who treat the majority of this illness. Although it is reassuring that both antidepressant medication and psychological treatments are effective for patients with mild to moderate disease, physicians are left with the practical consideration of choosing which therapy to use, knowing that neither has yet been shown to be superior. Individualizing the treatment decision requires consideration of local psychotherapy resources, relative expense of treatments, insurance coverage, and response to past therapies. Both patient and physician preferences are appropriate factors to consider when planning treatment for depression.



Source: American Family Physician. Kansas City: Dec 1, 2005. Vol. 72, Iss. 11; pg. 2309, 2 pgs

DSM-IV-TR CRITERIA
Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same
2-week period and represent a change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
NOTE: Do not include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations.
1. Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad or empty) or observation made by others
(e.g., appears tearful). NOTE: In children and adolescents, can be irritable
mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities
most of the day, nearly every day (as indicated by either subjective
account or observation made by others).
3. Significant weight loss when not dieting or weight gain (e.g., a change of
more than 5% of body weight in month), or decrease or increase in
appetite nearly every day. NOTE: In children, consider failure to make
expected weight gains.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by
others, not merely subjective feelings of restlessness or being slowed
down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may
be delusional) nearly every day (not merely self-reproach or guilt about
being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every
day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal
ideation without a specific plan, or a suicide attempt or a specific plan for
committing suicide.
B. The symptoms do not meet criteria for a mixed episode.
C. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiologic effects of a substance (e.g., a
drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by bereavement (i.e., after the loss of a
loved one, the symptoms persist for longer than 2 months or are characterized by
marked functional impairment, morbid preoccupation with worthlessness, suicidal
ideation, psychotic symptoms, or psychomotor retardation).

From American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

quote:

Originally posted by Marc Summers lol

hahaha "they"


i'm all for natural remedies to be honest. i know i've done my fair share of partying with the illegal shit, so it seems hypocritical, but when it comes to prescriptions, i'd much rather not take them. i hate going to the doctor when i'm sick...i'd rather just let it run its course, rather than rush to the doctor to get antibiotics, which only make you get better 24 hours quicker than without them anyway...

___________________

My soliloquy may be hard for some to swallow, but so is cod liver oil.

quote:

Originally posted by notelfreak man i can't believe i tried to come off as responsible in that other thread, i am so full of shit just don't tell anyone