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post #1 of 14 (permalink) Old 11-29-2009, 05:01 PM Thread Starter
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No Added Benefit of Adjunctive Psychotherapy to Antidepressants Alone in Chronic Depr


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November 16, 2009 — Adjunctive psychotherapy in combination with antidepressant medication appears to offer no additional therapeutic benefit in patients with chronic depression, a large, randomized, 12-week trial suggests.

Investigators at Weill Cornell Medical College in New York found that after 12 weeks of continued pharmacotherapy plus either brief supportive psychotherapy (BSP) or cognitive behavioral analysis system of psychotherapy (CBASP), outcomes were no better than if patients received medication alone.

"It would be fair to say that the approaches were equally effective," lead investigator James H. Kocsis, MD, told Medscape Psychiatry.

The study is published in the November issue of Archives of General Psychiatry.

Findings Contrary to Study Hypothesis

The trial included 491 patients with chronic depression. Participants had depressive symptoms for a minimum of 2 years without remission and met diagnostic criteria for double depression, chronic major depression, or recurrent major depression with incomplete recovery between episodes.

The study's main outcome measures were proportion of remitters, partial remitters, and nonresponders and change from baseline in the Hamilton Scale for Depression scores.

Participants were randomized to receive 12 weeks of continued pharmacotherapy plus CBASP, continued pharmacotherapy with BSP, or continued optimized pharmacotherapy alone.

At the end of the study period, the investigators found no statistically significant differences among the 3 treatment groups in the proportions of patients in remission, partial response, or nonresponse, suggesting, said Dr. Kocsis, that although chronic depression is often helped by medication, there is little evidence of added benefit with adjunctive psychotherapy.

"We were surprised. The results went against our hypotheses. We are interested in studying differential predictors of response to drugs versus psychotherapy. We think early life adversity and childhood maltreatment may be important in predicting need for psychotherapy," Dr. Kocsis said.

Dr. Kocsis also noted that current American Psychiatric Association treatment guidelines only address major depression and not chronic depression. "Perhaps they should develop separate guidelines for chronic depression," he said.

Convincing but Not Conclusive

Pim Cuijpers, PhD, who has published 2 meta-analyses of psychotherapies for chronic depression, described the Kocsis study as "sobering." Dr. Cuijpers is professor of clinical psychology, chair of the Department of Clinical Psychology, and vice-director of the EMGO Institute for Health and Care Research at VU University, Amsterdam, The Netherlands.

Dr. Cuijpers told Medscape Psychiatry that, although he finds these data convincing, they are not conclusive. "The conclusion that pharmacotherapy alone is just as good as combined treatments is not supported by the total body of research in this area," he said.

The Cuijpers' meta-analysis of psychotherapies for chronic depression, which is currently in press, concluded that combined treatments have a small benefit over pharmacotherapy alone.

"I do not think the Kocsis study [which was published after the meta-analysis was completed] would change the results of our meta-analysis if it had been included. Our meta-analysis, however, also shows that the results of psychotherapy are not very high in chronic depression," Dr. Cuijpers said.

The study was sponsored by the National Institute of Mental Health. All medications were donated by Forest Laboratories, GlaxoSmithKline, Organon Pharmaceuticals Inc, Pfizer Inc, and Wyeth Pharmaceuticals. Dr. Kocsis reports receiving research support from AstraZeneca, Burroughs Wellcome Trust, CNS Response Inc, Forest Pharmaceuticals, the National Institute on Drug Abuse, the National Institute of Mental Health, Pritzker Consortium, and Sanofi Aventis; participating on the speaker's bureau for AstraZeneca, Pfizer Inc, and Wyeth; and acting as a consultant to Wyeth.
http://www.medscape.com/viewarticle/712439

Disclaimer: I am not a professional, all my advice is based on my own research and experiences.

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post #2 of 14 (permalink) Old 11-29-2009, 05:22 PM
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This study is excellent evidence on how psychological disorders that don't stem from false/irrational beliefs can't be treated with psychotherapy. If there are no false thought patterns, then therapy just won't work.

It applies to forms of SA as well, since the primary factor that causes SA for many is difficulty maintaining conversation, lack of social reward, an unexplainable feeling of discomfort, etc.
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post #3 of 14 (permalink) Old 11-29-2009, 08:54 PM
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This study is excellent evidence on how psychological disorders that don't stem from false/irrational beliefs can't be treated with psychotherapy. If there are no false thought patterns, then therapy just won't work.

It applies to forms of SA as well, since the primary factor that causes SA for many is difficulty maintaining conversation, lack of social reward, an unexplainable feeling of discomfort, etc.
Hmm.. I think changing thinking patterns, even wishful thinking can help with depression, or at least being able to bring someone out of major depressive episode. As someone who has suffered from depression and SA my whole life, it took a lot of positive thinking to get me out of some of my darkest moments. Too bad when the Pink Elephant fades away, and my problems are just too evident, I usually get slammed back to reality at full force and life becomes more unbearable than before. Then, no matter how much CBT or restructuring of my cognitive processes I do can save me. Even though, I might not have a real good idea of how CBT works since most of my therapist who claimed they did CBT were actually just talk therapist, although I have read a couple books by the pioneers Dr. Beck, and Albert Ellis.

I think sometimes when I brain storm ways to beat SA, and when I put in work and I fail miserably, no amount of cbt-therapy or myself, can talk myself out of believing that I have a condition that's probably part biology and partly how I was raised and the traumatic experiences accumulated. Although because I believe it has to do with biochemistry in some aspect, I still don't think the current psychiatric drugs are our answers, and probably never will be. All good drugs are usually so good (at the time of using), are highly addictive, and the good drugs that continue to come out will probably be slapped with a schedule I or schedule II. And all these due will bring us temporary breaks from reality, unjustified euphoria, false confidence, and blunted emotions. Take the medication away from the situation and is you brain chemistry any better off?

This study does not say anything like psychotherapy is better than medications, or likewise, it just says that when combined they are no more effective than the each one on there own. This is same with psychotherapy, add a medication and the results don't get better, I just saw a study that said just that.

I think a lot of therapy has a lot to do with finding someone you can build rapport with, and that understands you and actually cares about you and is just not going through the motions. Which to me if very hard to find, usually the best ones to me are the ones that don't have a in house psychiatrist, because when the goings get tough all they will start recommending you pills that they especially know nothing about, saying that you have a imbalance either because they are getting paid for or told by there manager to refer you to there psychiatrist or because there lazy and it easier for them to tell you to just take drugs. Also, for some reason I find it easier to talk to woman they seem to care more about emotions, except for a couple younger therapist I had, they both were awesome, but that is said for all younger therapist because i'm guessing they haven't had as much failures, like people offing themselves, and they are generally more enthusiastic and believe that they can help you, and this sort of help you're morale. I actually saw a study where they paid people money to go talk to older people and just be there friend, and this worked for depression just as much or more than professional psychologist or psychiatrist. Maybe we all should start posting ads on craigs list offering to pay people to be our friends.
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All medications were donated by Forest Laboratories, GlaxoSmithKline, Organon Pharmaceuticals Inc, Pfizer Inc, and Wyeth Pharmaceuticals. Dr. Kocsis reports receiving research support from AstraZeneca, Burroughs Wellcome Trust, CNS Response Inc, Forest Pharmaceuticals, the National Institute on Drug Abuse, the National Institute of Mental Health, Pritzker Consortium, and Sanofi Aventis; participating on the speaker's bureau for AstraZeneca, Pfizer Inc, and Wyeth; and acting as a consultant to Wyeth
Woah, a paper that discloses who paid for the study and the Dr. involved is on the speaker bureau which generally means that he is getting kickbacks from big pharma. I am surprised no one has yet thrown money at medscape to make this bottom part go away.

Any one else except me think pharmaceutical companies who spend the second highest amount on television ads, $4.3 billion, only trumped by the auto industry, should be barred from funding studies, paying some what respectable doctors to be on there team and in return write in journals, magazine, and speak around the country on there behalf most of the time without disclosing it. With all that goes into ads, 4.3 bill to the US, the country that consumes over 80% of all drugs, you have to think there is a lot of greed going on.

WARNING: With a name like Dangerous why would you ever take medical advice from me?
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post #4 of 14 (permalink) Old 11-29-2009, 10:53 PM
 
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Trying to talk someone out of a mental illness is like trying to talk someone out of a physical illness. In fact a mental illness DOES have physiological causes. Psychotherapy for the most part is quackery.
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post #5 of 14 (permalink) Old 11-29-2009, 10:56 PM
 
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Originally Posted by Dangerous View Post
Any one else except me think pharmaceutical companies who spend the second highest amount on television ads, $4.3 billion, only trumped by the auto industry, should be barred from funding studies, paying some what respectable doctors to be on there team and in return write in journals, magazine, and speak around the country on there behalf most of the time without disclosing it. With all that goes into ads, 4.3 bill to the US, the country that consumes over 80% of all drugs, you have to think there is a lot of greed going on.
Simply because it isn't perfect doesn't mean we'd be better off if they couldn't fund studies.
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post #6 of 14 (permalink) Old 11-29-2009, 11:07 PM
 
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This was a 12 week trial. Psychotherapy, in order to be effective takes years of dedication of behalf of both people involved. This is not in the least an accurate study.
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post #7 of 14 (permalink) Old 11-29-2009, 11:38 PM
 
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This was a 12 week trial. Psychotherapy, in order to be effective takes years of dedication of behalf of both people involved. This is not in the least an accurate study.
It's not unreasonable to expect treatment to show effectiveness in under 12 weeks.
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post #8 of 14 (permalink) Old 11-30-2009, 12:34 AM
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Quote:
Originally Posted by IllusionalFate View Post
This study is excellent evidence on how psychological disorders that don't stem from false/irrational beliefs can't be treated with psychotherapy. If there are no false thought patterns, then therapy just won't work.

It applies to forms of SA as well, since the primary factor that causes SA for many is difficulty maintaining conversation, lack of social reward, an unexplainable feeling of discomfort, etc.
In CBT I discovered that they weren't really trying to make your mind go into beliefs that were more true, just beliefs that were equally false that leaned more on the positive spectrum. In the end I discovered it just wasn't for me. It makes me think, what would we be if we just eliminated our beliefs? It sounds damn scary. For who am I w/o beliefs? But I wonder what it would be like, approaching this world as if it were a blank slate, what a wonderful experience that would be to have....

Anyways, I found drugs to be way more effective than CBT at making me feel better, and possibly changing my perceptions and habits.
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post #9 of 14 (permalink) Old 11-30-2009, 10:35 AM
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Although any improvement so far has been minimal, it took me a good 6 months to warm up to my therapist. I think at the very least the experience has helped me able to be more open about my feelings with my family and psychiatrist, which is a pretty small step I guess, considering I've been going bi-weekly for just over a year now.

But... while I once felt I was really wasting my time, to the point where I was constantly considering dropping it and even asked my psychiatrist what the heck we were supposed to be doing, now that I've become really comfortable with my therapist (who's a really nice person that's somehow able to never make me feel judged... which is difficult), I find the whole experience to be really fun and it's one of if not the only thing I can genuinely look forward to these days.

Besides, I'm not paying for it, and the alternative would be twiddling my thumbs at home anyways, so it's a bit of a no-brainer for me, regardless of the evidence for or against it. Because I've always made an effort to look at things rationally though, CBT has done me zero good. But I just can't help but personally see a lot of advantage for severe SA sufferers in particular with prolonged talk therapy... the trusting relationship one can eventually build with a therapist is an absolutely invaluable experience.

Perhaps obviously, from this perspective, I see the real value in psychotherapy to come from the character of the therapist themselves, rather than any particular psychotherapeutic model being used. Something that's absolutely impossible to control for or even measure in scientific trials.

This study also focuses specifically on short-term therapy in the treatment of chronic depression alone, something that shouldn't really apply to ANYBODY that's a member of a social anxiety forum, and so I wouldn't be too hasty to extrapolate the results to imply anything greater.
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post #10 of 14 (permalink) Old 12-04-2009, 03:20 AM
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Woah, a paper that discloses who paid for the study and the Dr. involved is on the speaker bureau which generally means that he is getting kickbacks from big pharma. I am surprised no one has yet thrown money at medscape to make this bottom part go away.

Any one else except me think pharmaceutical companies who spend the second highest amount on television ads, $4.3 billion, only trumped by the auto industry, should be barred from funding studies, paying some what respectable doctors to be on there team and in return write in journals, magazine, and speak around the country on there behalf most of the time without disclosing it. With all that goes into ads, 4.3 bill to the US, the country that consumes over 80% of all drugs, you have to think there is a lot of greed going on.
I wouldn't jump to a "OMG CONSPIRASEE" conclusion based off that. First of all, the study was conducted at a college and was sponsored by the National Institute of Mental Health rather than the pharmaceutical companies. Second, psychotherapy is not written off:
Quote:
"We think early life adversity and childhood maltreatment may be important in predicting need for psychotherapy," Dr. Kocsis said.

Dr. Kocsis also noted that current American Psychiatric Association treatment guidelines only address major depression and not chronic depression. "Perhaps they should develop separate guidelines for chronic depression," he said.
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post #11 of 14 (permalink) Old 12-04-2009, 03:30 AM
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Woah, a paper that discloses who paid for the study and the Dr. involved is on the speaker bureau which generally means that he is getting kickbacks from big pharma. I am surprised no one has yet thrown money at medscape to make this bottom part go away.

Any one else except me think pharmaceutical companies who spend the second highest amount on television ads, $4.3 billion, only trumped by the auto industry, should be barred from funding studies, paying some what respectable doctors to be on there team and in return write in journals, magazine, and speak around the country on there behalf most of the time without disclosing it. With all that goes into ads, 4.3 bill to the US, the country that consumes over 80% of all drugs, you have to think there is a lot of greed going on.
Very Well stated. ----its all a conspiracy, man. im serious. it is. but everything is a conspiracy, so nobody cares about conspiracies anymore, because they are just conspiracies...until someone realizes something, or something bad happens, then its not a conspiracy any longer... Then everybody freaks out. But until somebody says something or speaks up its all a conspiracy..

Big Pharma is a conspiracy....but no one cares because its a conspiracy. But if everyone acutally knew how they are getting robbed by Big Pharma.....how these companies exist NOT to develop drugs to cure diseases, but simply to make $$$. Its not about the patients, its about the money. This is made obvious...look at all the undeveloped, unmarketed, reasearch chemicals out there, with a tiny little Wikipedia entry, saying that "this drug may show a capacity to improve depressive patients, but further research is needed"----

I by no means am trying to bash all psychiatrists and all of Big Pharma....their drugs have saved my life. There are many good, caring, reputable psychiatrists and employees in the Big Pharma business. Im just saying....if one looks at the big picture, the overall Intentions of Big Pharma as a Whole become clear.....It is not a conglomeration of Research Institutes.... It is a Business.

Because I know that here today, the Black Knights,..... will emerge victorious, once again.
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post #12 of 14 (permalink) Old 12-04-2009, 03:48 AM
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I wouldn't jump to a "OMG CONSPIRASEE" conclusion based off that. First of all, the study was conducted at a college and was sponsored by the National Institute of Mental Health rather than the pharmaceutical companies. Second, psychotherapy is not written off:
LOL man....i wish i woulda seen this post before i published my conspiracy report. ....u know what i mean though, like im not saying its all a conspiracy. im just saying, its all .....i just don't have a better word. conspiracy doesnt quite fit, but its the only one i can find.

Because I know that here today, the Black Knights,..... will emerge victorious, once again.
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post #13 of 14 (permalink) Old 12-04-2009, 06:48 AM
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LOL man....i wish i woulda seen this post before i published my conspiracy report. ....u know what i mean though, like im not saying its all a conspiracy. im just saying, its all .....i just don't have a better word. conspiracy doesnt quite fit, but its the only one i can find.
Lol don't mind me, I'm just playing the devil's advocate .

I agree with your last post though, Big Pharma is all about $$$ and nothing more. Even in this study, apparently all they did was donate the medication solely as a form of advertisement.
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post #14 of 14 (permalink) Old 12-04-2009, 10:19 AM
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Although any improvement so far has been minimal, it took me a good 6 months to warm up to my therapist. I think at the very least the experience has helped me able to be more open about my feelings with my family and psychiatrist, which is a pretty small step I guess, considering I've been going bi-weekly for just over a year now.

But... while I once felt I was really wasting my time, to the point where I was constantly considering dropping it and even asked my psychiatrist what the heck we were supposed to be doing, now that I've become really comfortable with my therapist (who's a really nice person that's somehow able to never make me feel judged... which is difficult), I find the whole experience to be really fun and it's one of if not the only thing I can genuinely look forward to these days.

Besides, I'm not paying for it, and the alternative would be twiddling my thumbs at home anyways, so it's a bit of a no-brainer for me, regardless of the evidence for or against it. Because I've always made an effort to look at things rationally though, CBT has done me zero good. But I just can't help but personally see a lot of advantage for severe SA sufferers in particular with prolonged talk therapy... the trusting relationship one can eventually build with a therapist is an absolutely invaluable experience.

Perhaps obviously, from this perspective, I see the real value in psychotherapy to come from the character of the therapist themselves, rather than any particular psychotherapeutic model being used. Something that's absolutely impossible to control for or even measure in scientific trials.

This study also focuses specifically on short-term therapy in the treatment of chronic depression alone, something that shouldn't really apply to ANYBODY that's a member of a social anxiety forum, and so I wouldn't be too hasty to extrapolate the results to imply anything greater.
I also happen to have a really good therapist whom I look forward to talking to. She is a very nice person and makes me feel really comfortable and she is good looking to boot. She does not even have her Master's degree, but she is excellent. In my opinion a good therapist makes a world of difference.
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