In the News

9/24/2017    Administrator    In the News 0 Comments
A New Treatment for Depression - Really?
Chuck Ruby, Ph.D.
Pay attention to language! Here is a typical example of how language is used in mental health research in order to give the impression of medicine and disease, when in fact there is nothing medical or pathological about it. Yet, it is a linguistic smoke screen that obscures the real results.
JAMA Psychiatry recently published the results of a study that claims “whole-body hyperthermia” outperformed placebo in reducing the symptoms of depression. It sounds very clinical, medical, and based on an understanding of neuroscience. The study's lead paragraphs especially set the tone and give the impression of neuroscience at work. The researchers' conclude that hyperthermia "holds promise as a safe, rapid-acting, antidepressant modality with a prolonged therapeutic benefit." Isn't there a more direct way to say this?
If you take the time to dig into the weeds and see what this study is actually saying, it is quite commonplace. It is merely proposing that increased warmth can make people feel better. Didn’t we already know this? All the talk about brain structures and pathways activated during the process of warming is irrelevant, yet it is used to make depression sound like a matter of brain pathology and "whole-body hyperthermia" as medical treatment.
Beyond the critique of language, an examination of the data further question the value of this study.
To start off, the overall difference in depression between the "whole-body hyperthermia" group and the placebo group was minimal. At 6 weeks after treatment (the longest post-treatment assessment made), the hyperthermia group’s average score on the Hamilton Depression Rating Scale was about 12 and the placebo group’s average score was about 17. A Hamilton score of 12 is within the “mild” range and 17 is within the “moderate” range. The cutoff between mild and moderate ranges is 13-14. (For now let's ignore the issue of the 86% sensitivity and 92% specificity ratings of the Hamilton).
Added to the questionable meaning of these Hamilton score differences is the fact that the confidence intervals were quite large. For example, the 6 week difference in scores was 4.27. But the 95% confidence interval for this difference was 7.94 to .61. This means there is a 95% chance that the true difference between the groups’ scores was between 7.94 and .61, and a 5% chance the difference score was outside that range. Given that the cut off score between “mild” and “moderate” depression of the Hamilton is 13-14, claiming any practically significant difference between the hyperthermia group and placebo group is dubious.
Further, it must be remembered that the above Hamilton scores are group averages and they do not sufficiently account for the individuals’ scores. The two groups' score distributions overlap such that some in the placebo group did better than those in the hyperthermia group. At 6 weeks, the Cohen's d effect size between the groups was 1.66. At this value, about 40% of the two groups overlap. And remember, this is using the 4.27 Hamilton score difference, which is questionable given the large confidence intervals.
Finally, the placebo effect was greater for the hyperthermia group than placebo group. After the study, 94% of the hyperthermia group guessed correctly that they were in the experimental group, whereas only 71% of the placebo group thought they were receiving the experimental treatment. This would have artificially reduced the hyperthermia group's scores on the Hamilton based on the placebo effect alone.
Linguistic gymnastics are used in this and many other studies to give a medical model impression. More over, the very statistics reported ostensibly to justify a claim of superior treatment demonstrate the unconvincing nature of the results. Trivial effects, excessive confidence intervals, nomothetic washing away of individuality, and the placebo effect make this study of questionable use, other than to demonstrate that warmth can help some people feel better. How surprising is this?
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"Saving Psychiatry" - Dr. Joe's Blog

Breggin Fails in Court
Remember folks, Peter Breggin is on our (ISEPP’S) side; so, when Peter fails, we fail. Or do we? How did we/he fail this time?
Commonwealth of Massachusetts vs Michelle Carter. Guilty of manslaughter
Michelle was found guilty of encouraging, coaxing, pushing her despondent boyfriend, Conrad Roy, to kill himself. Peter noted that in June of 2014, Michelle was actually encouraging Conrad to get psychological help, not kill himself. In fact she volunteered to go with him to work on her own problem, an eating disorder. She was then started on Celexa by her doc (she had been taking Prozac for years). By July 2014, a month into her new antidepressant treatment, Peter noted she had become -- transformed if you will -- apathetic, prone to bouts of mania, nightmares in which the devil told her to kill herself. In addition, according to the “Psychiatric Times,” September 2017, p. 13, Peter also testified: [Carter] was enmeshed in a delusional system…really…a delusion where she’s thinking that it’s a good thing to help him die…[She] was unable to form intent because she was so grandiose that what she was doing was not to harm -- even though she was encouraging his suicide, her absolute intent was to help Conrad. Well, the judge would have none of it. (Michelle chose not to have a jury trial.) When Michelle encouraged him to poison himself with carbon monoxide, there was no indication of an attempt to “help.” This case bothers me. Although I am in Peter’s corner, railing against toxic substances poisoning the minds of vulnerable kids, I probably would have made the same judgment as Judge Lawrence Moniz. “The drug made me (her, him) do it!” is a slippery slope, particularly if you are of an existential bent as am I. We existentialists believe in personal responsibility. Note: Of all the drugs on the market, the drug causing the most violence is, you guessed it, alcohol. And alcoholic intoxication is not a defense in a court of law. 
So many culprits in this case
Yes, I know alcohol intoxication is quite different from taking a drug prescribed by an “expert.” When we drink alcohol, it is on our own recognizance. But, isn’t it peculiar that pregnant women are warned that alcohol might be injurious to the health of the fetus but there is no black box warning indicating that alcohol might impair judgment, remove social inhibitions, lead to violent actions towards others or oneself? What interests me is: WAS MICHELE EVER WARNED that Celexa could impair her moral judgment? How did the prescriber counsel her? Was she told that apathy was a possible effect? Most of all, the question is still open – where does personal responsibility end and professional responsibility begin? It is here that I am sympathetic to Judge Moniz’s decision. He is called upon to pass judgment on the person, not the system. There are so many culprits in this case: the careless prescribing physician; the corrupt pharmaceutical industry; distortions promulgated by the profession of psychiatry; the negligent families of each of these kids; society, with its futile dependence on pseudo-technical solutions to psychologic/spiritual problems. Michelle and Conrad were the end point of myriad influences. Conrad is dead. Michelle will do some jail time. Maybe she’s wiser. Are we? Let’s clarify something. It is a mistake to think that patients always follow doctor’s orders. There are very persuasive accounts in the literature that the opposite is true, particularly when it comes to antidepressants. Some examples:
  1. From Sawada, N et al. Persistence and compliance to antidepressant treatment in patients with depression: A chart review. BMC Psychiatry 2009:38. “In this retrospective chart review, 6-month adherence to antidepressants was examined in 367 outpatients with a major depressive disorder (ICD-10)… Only 161 patients (44.3%) [!] continued antidepressant treatment for 6 months.”
  2. From Warden D et al. Identifying risk for attrition during treatment for depression. Psychother Psychosom 2009:78:372-379. “The attrition rates in the first 12 weeks of treatment can be as high as 65% [!] in naturalistic setting (2,3,4) and 36% in clinical trials [5] and as many as 15% of the patients never begin a prescribed antidepressant [6].”
  3. From SansoneR.A. et al. in “Innovations in Clinical Neuroscience,” 2012. P41-46, “…approximately 50% of psychiatric patents and 50% of primary care patients prematurely discontinue antidepressant therapy…”
My sympathy goes out to Michelle and to Conrad’s family. I can’t explain why Michelle did not toss the drug down the drain, not wanting the effects that may have contributed to Conrad’s death. Often one’s desire to escape psychological pain has dire consequences. Is that what happened to Michelle Carter? “Die Conrad, I don’t want to feel your pain any more.”...

ISEPP In Action

8/16/2017    Administrator    ISEPP In Action 0 Comments
ISEPP's Hank McGovern has come out with a book on suicide prevention. Check it out at Amazon. Hank speaks from personal and professional experience. Take a look at his recent interview below with Michele Paiva, ISEPP's marketing guru. The book has received 5 stars out of 47 reviews so far. From one review: "The author artfully uses the dramatic frame of a suicide note and a tumultuous, well-drawn childhood to take readers through his quest for meaning, peace, and balance...His encapsulations of various therapies, particularly rational emotive behavior therapy, are soulful and illuminating, and emphasize the power of practical, positive action and  behavior...Overall, this is an evocative, intriguing, self-exploration...sometimes overwhelming, yet compelling..."...

 

20th Annual Conference of the International Society for Ethical Psychology and Psychiatry

Denver, Colorado
October 6-8, 2017

Mental Health:
Considering Context in Human Suffering

See the conference lineup and register!



ISEPP Demands Ethical Guidance from National Mental Health Associations Regarding the DSM



The Warfighter Advance

ISEPP has been the fiscal sponsor for Warfighter Advance, a unique and humane program for helping veterans and military deal with traumatic experiences without resorting to the medical model. ISEPP'f formal sponsorship is no longer need because in August 2017 they received their official non-profit status from the IRS.  Please take a look at the wonderful work they're doing. ISEPP is and will continue to support their work.