Welcome to the June 5, 2007 edition of carnival of depression, bipolar disorder, and mental health journeys.

In the depression category, Angela presents an important topic for women who are pregnant or have just delivered. For more information about this subject, please read my comprehensive review of the book, A Deeper Shade of Blue.

Jeff gives an honest and reflective look at the question, “am I depressed, and is this the kind that requires medication?” I find some of us migrate toward extremes - either denying there is any problem and refusing to seek help - or immediately labeling ourselves with multiple illnesses and begging for pills. We can save ourselves a lot of grief (not to mention risks of side effects) by spending some time asking ourselves some tough questions. (more…)

In Psychiatric Times March 2002 Vol. XIX Issue 3, Deborah Lott’s article, “Are Studies Misguiding the Choice of First-Line Treatments?” describes how Boston University’s psychologist Drew Western and colleagues reviewed 34 studies on psychotherapies in peer-reviewed journals, and is now suggesting that some of the first-line treatments may have been based on studies that weren’t as scientifically sound.

The 34 studies Western and colleagues reviewed were published in an 8-year span (1990-1998). These studies included panic disorder (17 studies), generalized anxiety disorder (GAD, 5 studies) and depression (12). Studies that did not meet minimum criteria for randomized control trials were not considered.

Some of the observations by Western and colleagues:

• Long-term follow-up to look at lasting effects of treatment were often missing (beyond, 12, 18, or 24 months)
• Some studies did not report why certain patients were not included (also known as “exclusion rates”)
• Panic disorder treatment showed the most impressive results where 63% of patients showed improvement
• 54% of patients with depression showed improvement but the analysis of existing study data did not show long-term effects
• 52% of generalized anxiety disorder patients showed improvement but no data was published for long-term follow-up

Why does this matter? Well, most physicians base their prescribing and treatment decisions on published studies. When many studies don’t look at long-term effects, what can we say about the effects of certain drugs used in the long term of as mental health treatment?

Of course, we also want to be very cautious of conclusions drawn from “meta-analyses” like this one. One of the drawbacks and criticisms in meta-analyses is that you may be comparing apples and oranges. You can’t pool a collection of studies for depression together and treat them like one clinical study - because there are too many different factors to consider. And conclusions drawn may not be accurate.

One thing that we can be certain though - long-term follow-up is needed in clinical studies. This is the only way we can look at how well some of these treatments work in the long-term.

This discussion is extremely long. Those who are interested can read it on Psychiatric Times.