Continuing the discussion from the last post, a new study has shown that anti-depressant medication (ADM) has no more benefit than a sugar pill (placebo) when depression is less than very severe (1). This evidence, though not necessarily a reason to halt prescription of ADM for patients in that category, should certainly make clinicians reconsider the risks and benefits and discuss the results of this research with their patients.
Archive for the ‘Stress Research’ Category
Depression News (4)
Thursday, February 4th, 2010Depression News (3)
Wednesday, February 3rd, 2010Continuing the discussion from the last post, the University of Pennsylvania study (1) concluded that anti-depressant medication (ADM) was no better than placebo (sugar pill) for people with mild, moderate or even severe depression as measured by the Hamilton Depression Rating Scale. Only in those with very severe depression by that scale was the improvement with ADM significantly greater than the improvement with placebo.
Depression News (2)
Tuesday, February 2nd, 2010The results from the JAMA paper (1, described in the last post) are reported using the Hamilton Depression Rating Scale. The scale is derived from a series of questions and scores are interpreted as follows: (more…)
Depression News (1)
Monday, February 1st, 2010In the U.S. alone, 27 million people take anti-depressant medication. This is approximately 10% of the population of teens and adults. With numbers like that, it is not surprising that a recent study (1) received a great deal of attention from national and local news media.
Smith and Dwamena (2)
Friday, January 22nd, 2010Continuing our review of the Smith and Dwamena paper (1), they describe a spectrum of severity for patients with medically unexplained symptoms (MUS). The few patients who fully meet criteria for Somatoform Disorder (2) are severely ill. The rest range from mild to not quite as severe as those with Somatoform Disorder. The group with mild MUS is the largest. Their symptoms tend to be of short duration, resolve on their own, usually don’t require much medical care and aren’t associated with significant mental health issues. They can be managed with a Stress History (see earlier posts with this tag), observation over time and a minimum of diagnostic tests.
Smith and Dwamena (1)
Thursday, January 21st, 2010We have seen that diagnosis and treatment of medically unexplained symptoms (MUS) in a primary care clinic is completely inadequate (see the posts tagged Kroenke and Blindspot). Smith and Dwamena (1) agree. They point out that MUS patients comprise half or more of all outpatients and often are subjected to the risk and cost of “ill-advised lab testing and trial treatments” and seldom receive adequate treatment in primary care. (If the same could be said of, say, diabetes, there would be an international uproar and diabetes isn’t half as common as MUS.)
Kroenke & Mangelsdorff (2)
Friday, January 8th, 2010To continue discussion of the Kroenke & Mangelsdorff research*, let’s begin by looking at what became of all 567 symptoms (in 380 patients). For 2/3 of the symptoms, doctors did diagnostic testing or referred to a specialist. In the other 1/3, no evaluation was done beyond the initial visit. Treatment was recommended for only 55% of symptoms, and this took the form of a prescription in over ¾ of cases. There was nothing to suggest that anyone searched for hidden stresses linked to the symptoms (posts tagged with “Stress History” explain how this is done).
Kroenke & Mangelsdorff (1)
Thursday, January 7th, 2010Last year marked the 20th anniversary of one of the most frequently quoted studies in the stress illness literature. The paper reports a discovery that would have shocked me if I had read it during my training years. Their finding has profound implications for primary care practice.
Stress and Disease of Body Organs (2)
Wednesday, January 6th, 2010Continuing on the theme of stress and disease of body organs, a recent study* of post-traumatic stress disorder (PTSD) from Hamburg, Germany begins by citing research by others that war veterans with PTSD have been shown to have more illness of the heart, lungs, nerves and digestive system than war veterans without PTSD.
Stress and Disease of Body Organs (1)
Tuesday, January 5th, 2010My usual focus is on the connection between stress and physical symptoms that are not explained by detectable disease. However, there is also research showing a link between stress and diseases of body organs. An earlier post (Adults who had Stress in Childhood (2)) reviewed results from the Adverse Childhood Experience (ACE) Study led by Vincent Felitti and Robert Anda.
