An ounce of prevention

An Ounce of Prevention
November 2015
Issue 227
Website: drsgaryjoannmeierspsychologist.com Gary J. Meiers, Ph. D., Jo Ann Hammond, Ph. D., Phone: (780) 433-2269 & Associates, Ltd. Fax: (780) 431-0463 10009 – 85 Avenue, Edmonton, AB T6E 2J9 Wisniewski and his team divided the STAR*D patients Why Antidepressants Don't Live
into two groups — an "efficacy" sample of patients who would normally be included in a typical Phase III clinical Up to the Hype
trial for a new antidepressant and a "nonefficacy" sample of patients who would normally be rejected. In the '90s, Americans grew fond of the idea that you can Depressed STAR*D patients who were classified for fix depression simply by taking a pill — most famously inclusion had no more than one general medical condition fluoxetine (better known as Prozac), though fluoxetine is (like, say, heart disease) and no more than one additional just one of at least seven selective serotonin reuptake primary psychiatric disorder besides depression. All inhibitors (SSRIs) that have been prescribed to treat patients with multiple comorbidities — along with anyone hundreds of millions of people around the world. whose depression had lasted more than two years — were excluded. Once the authors crunched all the numbers, they But in the past few years, researchers have challenged the found that only 22% of STAR*D patients met entry criteria effectiveness of Prozac and other SSRIs in several studies. for a conventional antidepressant trial. in February attributed 68% of the benefit from All the STAR*D patients were taking citalopram, an SSRI antidepressants to the placebo effect. Likewise, a marketed in North America as Celexa. Not surprisingly, a year earlier suggested that those who met standard inclusion criteria for a clinical trial widely used SSRIs, including Prozac, Effexor and Paxil, had significantly better outcomes on the drug. In the offer no clinically significant benefit over placebos for efficacy group, 52% responded to Celexa vs. 40% of the patients with moderate or severe depression. Meanwhile, nonefficacy group. Patients in the latter group also took pharmaceutical companies maintain that their research longer to respond and had to be readmitted to psychiatric shows that SSRIs are powerful weapons against settings more often. "Thus," the authors conclude, "current depression. that summarizes the efficacy trials suggest a more optimistic outcome than is likely in practice, and the duration of adequate treatment suggested by data from efficacy trials may be too short." Now a major new study suggests that both critics and proponents might be right about SSRIs: the drugs can To bolster their findings, the authors cite a smaller 2002 work, but they appear to work best for only a subset of study that arrived at similar results: iublished depressed patients — those with a limited range of in the American Journal of Psychiatry, Dr. Mark psychological problems. People whose depression is Zimmerman of Brown University and his colleagues found compounded with, say, substance abuse or a personality that of 315 patients with major depressive disorder who disorder may not get much help from SSRIs — which is sought care, only 29, or 9.2%, met typical criteria for an unfortunate for the 45% to 60% of patients in the U.S. who efficacy trial. Similarly, psychologist Ronald Kessler of have been diagnosed with a common mental disorder like Harvard co-authored ain the Journal of the depression and al American Medical Association that concluded that most ike substance abuse. (Multiple diagnoses are "real world" patients with major depression would be known in medical parlance as comorbidities.) excluded from clinical trials because of comorbidities. Such findings help explain why antidepressants haven't Theished online in April by the American quite lived up to their promise. Journal of Psychiatry, was conducted using data from a large, government-funded trial called Sequenced Treatment But the University of Pittsburgh's Wisniewski, the lead Alternatives to Relieve Depression, which usually goes by author of the new study, cautions against interpreting the the moniker STAR*D. The STAR*D project, which results as an indictment against greedy drug companies collected data from 2001 to 2004 at 41 U.S. psychiatric eager to exclude difficult patients in order to show better facilities, was one of the most ambitious efforts ever to results. "If the population in a [clinical] trial were more understand how best to treat people with major depression. representative, that would come at a cost," he says. STAR*D participants comprise a powerful research sample Researchers expect a certain number of bad reactions because they are highly representative of all depressed during clinical trials; some of these reactions can cause Americans. Very few depressed people were excluded serious medical problems. If patients enter a trial with from STAR*D; only women who were pregnant, those multiple complications — if they are, say, not only with seizure disorders and a few others with acute depressed, but also cocaine-addicted, hypertensive and conditions were kept out. All other psychiatric and medical diabetic — you dramatically increase the chances of co-morbidities were allowed. adverse side effects. "That's why trials to determine efficacy are done on a relatively homogeneous population," The authors of the new paper, a team of 11 researchers led Wisniewski says. by University of Pittsburgh professor of epidemiology Stephen Wisniewski, were curious how the STAR*D That's understandable, but the new study does shed light on group would compare with a typical group of patients the limitations of antidepressants. Conducting clinical trials selected for a run-of-the-mill drug-company trial for a new with representative samples would undoubtedly be more antidepressant — the very trials on which the Food and complex — and expensive — since patients with multiple Drug Administration bases its decisions regarding new risk factors would have to be monitored more carefully. drug approval. Drawing on their own experiences in But for a future generation of antidepressants to be truly helping to conduct such trials, which have far more effective for most patients, more-inclusive trials may be stringent inclusion criteria than the STAR*D group, the best answer. For the online article please visit:  Alcohol is the third leading lifestyle-related contributor to death in the U.S. after tobacco and diet/activity patterns.  Alcohol-related traffic crashes make up the Change One Thing
fifth leading cause of death for Americans of all ages. Sometimes we don't make changes because they are  Research suggests alcoholism is more strongly too difficult of daunting or we are "fixin' to get related to child abuse than other disorders, ready," as my friend Helen says. One way to get such as parental depression. change going is to consider the smallest change you  Alcohol and/or drugs are very likely involved can make and begin. Often inertia will continue to in at least 81% of reported cases of child abuse take you in the direction of change once you start. If in this country, according to state welfare not, at least you are moving forward a little. As Milton Erickson used to say, "If you fall on your face,  Children of alcoholics are more likely than at least you are heading in the right direction." non-COAs to develop disruptive behavioral problems, anxiety, depression, and poorer Identify the smallest change you can make and
school performance.  Children of alcoholics experience greater If you want to write a book and aren't getting it done, physical and mental health problems and try writing one word a day. I used to recommend five higher health care costs (32% higher) than minutes a day (which is fine if that works for you), children from non-alcoholic families. but if even five minutes seems too much, start with  Only one in 20 children of alcoholics gets
one word a day. Clean up, organize, or toss one piece any help. Yet, there is growing evidence
from that stack of papers/mail/magazines cluttering that with help, these children can learn to
your house or office. thrive, become resilient, and change their
Commit to a limited period of time for the change
You could commit to walking for five minutes a day National Institute on Alcohol Abuse and Alcoholism for the next week. Or de-cluttering that pile of papers for the next three days. Forever is too daunting for National Association for Children of Alcoholics most. Time-limited often works better. National Institutes of Health Journal of the American Medical Association Focus on only one thing at a time
Stop multi-tasking and experiment with doing only ***Net News***
the thing you are doing. Or attend only to the person Here are some web sites you & your family or experience you are with at the moment. Listen to may find helpful. and watch the person you are conversing with (rather than texting, glancing at the television, thinking about A video from Alberta Family Wellness Initiative what you will do or say next, etc.). Eat when you are changes minds by informing Canadians about effects eating. Drive when you are driving. of toxic stress on kids' brains: Build a new habit one day at a time
Do the new habit for 5 minutes each day until it becomes ingrained, then expand the time or effort you TED talks: childhood trauma and how it can affect your health across a lifetime: Dismantle an old, unhelpful or unhealthy habit one
piece at a time
Change one small thing about the old habit. Drink half a soda and half a glass of water with a meal instead of ***Self- Help Corner:***
a soda. Park a little farther away from the store or Alcoholics Anonymous: your workplace and walk a little. Eat everything that is unhealthy with your non-dominant hand. Al-Anon/Alateen: Support Network / Referral Line: Bill O'Hanlon, 223 N. Guadalupe #278, Santa Fe, NM Distress Line: _482-4357 Cocaine Anonymous: 780-425-2715 www.billohanlon.com, [email protected] Informative Links:
Children of Alcoholics:
Is Alcohol a Form of Depression? Important Facts
One in four children in America under the age of 18 is growing up with alcohol abuse or Are you in a dangerous relationship? alcoholism in the family.  Children of alcoholics (COAs) are four times more likely than non-COAs to become How Much Alcohol Is Too Much?

Source: http://www.drsgaryjoannmeierspsychologists.ca/doc/november_2015_issue_227.pdf