January 23, 2013
Look around the room and you’re likely to find at least one person who is on an antidepressant medication now. I just did a Google search for the “top prescription drugs” and according to Drugs.com, one antidepressant and another psychiatric medication are in the top ten ranking. I often perform this search with my patients and there have been times when three or even four of the top ten prescribed drugs have been antidepressants and antianxiety medications.
In a recent piece in The Daily Telegraph from the UK, a general practitioner spoke out about the overuse of such medications, often without adequate discussion about the potential side effects of these drugs. I couldn’t agree more. Now with that said, I should be clear: I often recommend (sometimes quite strongly) that some of my patients consider taking antidepressant and other psychiatric medications. We should not be polarized in our thinking about such treatment… these meds are often quite effective and when properly prescribed can have limited side effects (or we can even “leverage” the side effects to our advantage by prescribing antidepressants that have a more sedating side effect profile to patients with insomnia or meds with a more activating side effect profile to folks having trouble getting out of bed in the morning). But such medications should not be used instead of other treatments such as psychotherapy; they are typically most effective when used in conjunction with talk therapy. For more information see some of my other blog posts such as APA Promotes Psychotherapy and Use of Antidepressants.
October 17, 2012
The American Psychological Association (APA) recently launched a new awareness initiative about the benefits of psychotherapy. There are a couple cute videos (below) that mock the pharmaceutical commercials that we see too often. Though I very much appreciate this approach, I do not fully agree with the claim that psychotherapy has no negative side effects. I can’t think of anything we can ingest, be exposed to or do that doesn’t have some side effects; for example everything we do comes at the expense of something else that we otherwise could have done. I speak often about “compromise formation” with my patients and consulting clients, and with this concept, I believe firmly that psychotherapy does have side effects, but that they are almost always “worth it” from a cost-benefit analysis perspective.
Enjoy the videos…
February 26, 2012
A recent study drew a correlation between working overtime and the development of major depression… regardless of the “stress level” of the job. As a psychologist who works with a lot of physicians, nurses and other healthcare professionals (who often work very long hours, back-to-back shifts and rotating shifts) this is particularly relevant to my practice. In fact, a non-scientific article listed healthcare workers among the top ten careers associated with depression. It is particularly important for healthcare providers to be aware of the risks of mental illness and to seek appropriate treatment in a timely manner.
February 2, 2012
Last month, SAMSA released a report about the incidence of mental illness in America. A striking one in five (20%) of American adults experienced some sort of mental illness in the past year. Even worse, nearly 30% of young adults (ages 18-25) had a brush with mental illness in the past year. Women are more likely than men to have a mental disorder (23% vs 17%), though there is a gradual increase in the incidence of men dealing with psychiatric disorders.
Most disturbing is the fact that slightly less than half the people with any mental illness — and only 60 percent of those with serious, disabling ones — receive treatment each year. There are many obstacles to treatment, ranging from stigma and ignorance to financial and health care policies. This is clearly a growing issue that cannot be ignored.
January 10, 2012
Tomorrow the American Psychological Association (APA) releases the results from their annual “Stress in America” study. As part of the release of their findings, they will be holding a webcast tomorrow (Wed, 1/11/12 at 4:30pm EST) that is open to all. You can register online. For more information, go to APA’s Stress in America page.
October 20, 2011
The CDC just put out a report about Americans’ use of antidepressants. The paper has already gotten a bunch of press (Washington Post, CNN, Reuters to name a few). Some of the key bullet points of the paper are:
- Eleven percent of Americans aged 12 years and over take antidepressant medication.
- Females are more likely to take antidepressants than are males, and non-Hispanic white persons are more likely to take antidepressants than are non-Hispanic black and Mexican-American persons.
- About one-third of persons with severe depressive symptoms take antidepressant medication.
- More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
- Less than one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year.
Wow, that’s a lot of info to digest, but a couple points stand out for me: 1) only one third of severely depressed people take antidepressants, and 2) less than one third of people taking antidepressants have seen a psychologist, psychiatrist or social worker. What this means is that the people who most need antidepressant medication are not taking any, and most people who are taking such medication don’t access services that can either replace, or serve as adjunctive treatment to, the antidepressant medication they are already taking.
October 18, 2011
The Wall Street Journal just ran a nice little piece on how to go about choosing the right therapist. I love seeing articles like this in publications like that. The article noted there are different types of therapists, therapies, etc and that what works for one person might not work for the next.
I loved that the author suggested becoming an informed consumer when seeing psychotherapy, but readers should know that some of the suggestion questions are not always answerable. For example, it is perfectly appropriate to ask a therapist about his training or her experience in working with your particular symptoms. It is also quite reasonable to ask about the proposed treatment approach, duration of treatment, etc. However some of these questions cannot be answered definitively after just one session. For example, new patients to my practice often ask, at the end of the initial consultation, how long will therapy take. I explain that I really can’t answer that question with much confidence because there are simply too many variables – - known and unknown variables – - that will affect the duration of our work together.
I add that there are some folks I work with for just a handful of sessions and that is all they need to achieve their desired goals, and there are other people who I have worked with for several years. A key element within longer-term treatment is regularly circling back throughout the therapeutic process and reassessing if it is still appropriate to continue treatment; I would never want to work with a patient (and charge him or her, of course, for services rendered) and have the treatment not be of significant benefit. Ethically, any good psychologist would terminate treatment if s/he feels it is no longer of benefit to the patient.
September 27, 2011
A recently released study about the effects of coffee use on depression has gained quite a bit of “buzz” in the Wall Street Journal, the LA Times, the New York Times and the Washington Post. The study suggests that there may be a positive protective relationship between regular coffee use in women and developing depression. In other words, women who drink coffee on a regular basis may be at decreased risk of developing an episode of depression.
Now, I am not ready to start “prescribing” coffee to my female patients who are dealing with depression for many reasons. First and foremost, the study doesn’t suggest that coffee is necessarily useful in treating depression; it only speaks to preventing depression. But there are many other reasons as well, including the fact that though it may be tempting to believe that if we simply ingest a tasty beverage (or pill or herbal remedy or something else) we will be happy, life rarely is that simple.
I was pleased to read that the study mentioned the potential harmful effects of coffee intake. Perhaps the old mantra, “everything in moderation” applies here.
September 15, 2011
Time Magazine ran an interview style article with a recent president of APA that, in my opinion, demonstrated a horribly misguided understanding of psychotherapy. The piece starts out by addressing a very real and complex set of public health problems: there are many people in need of psychological treatment that don’t have access; there is confusion about what works in psychotherapy (and why); there are quacks out there treating patients without adequate training and supervision; etc. However the quality of the article quickly slides out of control with bizarre misrepresentations of psychotherapy efficacy literature, personal opinions stated as fact and other unsubstantiated claims about the benefits of psychotherapy.
I feel it was irresponsible of Time Magazine to run such a piece without a balanced perspective, without interviewing someone more familiar with or who has more in-depth understand of the psychotherapy efficacy literature.
June 2, 2011
Though the info isn’t new, it’s just as relevant as it was years ago…
Back in 1995 Consumer Reports published an article that touted the benefits of psychotherapy. The article offered several interesting conclusions: 1) patients benefited very substantially from psychotherapy, 2) long-term treatment did considerably better than short-term treatment, and 3) a combination of psychotherapy with medication did not differ in effectiveness from psychotherapy alone.
There were other interesting findings, including that no one modality of psychotherapy was better than any other, and that licensed, doctoral level mental health professionals were more effective than “marriage counselors” or being followed just by one’s primary care physician. Furthermore, when insurance companies interfered by determining the therapists to be used or determining the length of treatment, patients did worse.
Though this was not exactly a prime example of a peer-reviewed, randomized controlled trial measuring the efficacy of psychotherapy, it was a nice, easy to understand adjunct to the existing psychotherapy effectiveness literature.