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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on April 7, 2006, at 21:23:02
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 7, 2006, at 21:02:38
All studies attempting to *sses the efficacy of exercise for depression will be flawed based on the fact that they can't be blinded.
But, research into the area is not nonexistant.
http://www.medicalnewstoday.com/medicalnews.php?newsid=34197&nfid=rssfeeds
Linkadge
Posted by SLS on April 7, 2006, at 21:57:18
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 7, 2006, at 21:23:02
I just don't think it is justified to have someone with severe depression (MDD) forego all other treatments and commit to a trial of exercise that lasts for weeks or months. That's what we are talking about here. We aren't debating the desirability of exercise in general. We are not even speaking about the efficacy of exercise as an adjunct to other treatments. The question at hand is whether or not exercise alone is as effective as pharmacotherapy in the treatment of moderate to severe major depressive disorder or bipolar disorder. Right now, I don't think it is.
- Scott
Posted by SLS on April 7, 2006, at 22:14:29
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 7, 2006, at 21:23:02
> All studies attempting to *sses the efficacy of exercise for depression will be flawed based on the fact that they can't be blinded.
>
> But, research into the area is not nonexistant.
>
> http://www.medicalnewstoday.com/medicalnews.php?newsid=34197&nfid=rssfeeds
Maybe I'm reading this article wrong, but it seems that parts of it bolster my argument:"It's also possible that exercise's effect on mental health is an illusion, says the Harvard Mental Health Letter."
"Even controlled trials on the subject often have problems, such as insufficient follow-up, the difficulty of correcting for the effect of expectations, and the fact that people who volunteer for exercise studies are not necessarily typical."
- Scott
Posted by Sobriquet Style on April 8, 2006, at 6:06:09
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by greywolf on April 7, 2006, at 13:05:49
>It refers to the multitude of "get out and enjoy the fresh air" and "mind over matter" folks who think simple lifestyle changes will cure serious mental illnesses.
In that respect, i'm glad to say we are not the ones which need help, treatment and education. :-)
~
Posted by Sobriquet Style on April 8, 2006, at 6:22:49
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 21:57:18
>I just don't think it is justified to have someone with severe depression (MDD) forego all other treatments and commit to a trial of exercise that lasts for weeks or months. That's what we are talking about here. We aren't debating the desirability of exercise in general. We are not even speaking about the efficacy of exercise as an adjunct to other treatments.
I thoroughly agree. Like I said in my previous post I wouldn't forego other treatments eg medication, in favour of exercise alone. I do support, for myself, exercise as an adjucnt treatment. Really though, I can't say i'm starting an exercise routine as a treament for bipolar disorder. Its more from an holistic health point of view to gain an increased sense of well-being, which in turn if that can aid in the smallest sense to helping me with the illness, then thats a bonus. At the very least I'll feel more pleased with myself when I look into the mirror for self esteem and reduced fat!
I want to finally mention that I have reviewed your website with extensive medication information. I think on your main website I came across photos of yourself with an excellent toned physic. Alot of hard work must of gone into that training, very impressive and a supurb psychic! :-)
Best of luck with starting up risistant weight training again. I've just started myself, the first few days were the toughest, but now the aches and pains are slowly beginning to subside..
~
Posted by SLS on April 8, 2006, at 6:43:10
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Sobriquet Style on April 8, 2006, at 6:22:49
> >I just don't think it is justified to have someone with severe depression (MDD) forego all other treatments and commit to a trial of exercise that lasts for weeks or months. That's what we are talking about here. We aren't debating the desirability of exercise in general. We are not even speaking about the efficacy of exercise as an adjunct to other treatments.
>
> I thoroughly agree. Like I said in my previous post I wouldn't forego other treatments eg medication, in favour of exercise alone. I do support, for myself, exercise as an adjucnt treatment. Really though, I can't say i'm starting an exercise routine as a treament for bipolar disorder. Its more from an holistic health point of view to gain an increased sense of well-being, which in turn if that can aid in the smallest sense to helping me with the illness, then thats a bonus. At the very least I'll feel more pleased with myself when I look into the mirror for self esteem and reduced fat!
>
> I want to finally mention that I have reviewed your website with extensive medication information. I think on your main website I came across photos of yourself with an excellent toned physic. Alot of hard work must of gone into that training, very impressive and a supurb psychic! :-)
>
> Best of luck with starting up risistant weight training again. I've just started myself, the first few days were the toughest, but now the aches and pains are slowly beginning to subside..How many times a week do you intend to work out? I found that it takes a little longer (LOL) for the body to recover after age 40. I think I might start at 2-3 a week. I might walk or run on the off days. Linkadge said something important along another thread. It is possible to overtrain such that it becomes counterproductive for mood enhancement. I tend to perform each set of exercise until I reach momentary muscle failure. It is intense, but very efficient. That's why the 2-3 times per week to start with. If I find that I get the "itch" again, which I doubt, I'll then split my routine and workout 4 times a week. Anything more will produce a state of overtraining in which the rate of progress is diminished. There must be a balance between intensity and volume.
- Scott
Posted by Sobriquet Style on April 8, 2006, at 8:01:36
In reply to Re: Drugs versus Psychotherapy - Backlash? » Sobriquet Style, posted by SLS on April 8, 2006, at 6:43:10
>How many times a week do you intend to work out?
At the moment 3, i'm aiming for 4 and doubt i'll go higher than that.
>I found that it takes a little longer (LOL) for the body to recover after age 40.
LOL I can imagine. I've quite literally been very unactive for nearly 2 years. On previous attempts on the weights, I'd do some (for one day) my muscles would ache so much after afew days of them recovering I wouldn't continue. This pattern went on for quite afew months - train - stop - train - stop. Absolutely pointless! Fortunately, I re-started reducing the level of weights, now I've gradullly increased them to a half respectable level and things are going good.
>I think I might start at 2-3 a week.
Thats sounds like sensible idea. I need to refresh my knowledge, but I'd certainly say that to start off with go very slow, listen to your body and only increase when you feel ready too. If memory serves me right when you get into an established routine, it maybe that after 3 days of doing no weights, you can lose alot of the effort you gained previously. I may well be wrong, I need to seek some information soon for when I see some improvements on how to stabilize my progress or increase it in a sensible way.
>I might walk or run on the off days.
That sounds like a good idea..
>I tend to perform each set of exercise until I reach momentary muscle failure. It is intense, but very efficient.
Me too. At present i'm using a method i've used before similar to boxing training that has worked for me in the past. I'll do intense lifting for a specific area for a few minutes. Then change to a differnet area, then change again eg abs, then afew mintues on a skipping rope. Keep this in rotation for about 30mins. I've also got a machine for aerobic exercise. I'm using free weights and a bench press. Fortunately this is all at home so my gym costs are cheap :-)
>Anything more will produce a state of overtraining in which the rate of progress is diminished. There must be a balance between intensity and volume.
For sure, finding that balance is crucial.
I hope to find ways of sustaining my interest levels with the training, so that it doesn't feel like a chore. I'm thinking of introducing swimming possibly at a later date, and possibly taking photos to keep track of my progress, so that when I feel like giving up I can see the, hopefully LOL, huges benefits i've made.
~
Posted by greywolf on April 8, 2006, at 10:24:31
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Sobriquet Style on April 8, 2006, at 8:01:36
If you're starting aerobic exercise, I'd recommend going to the Runner's World website. They usually have links that outline a realistic training program geared toward where you are physically when you start it. At first glance, you think "wow, they don't even have me running a couple miles for 8 weeks," but when you think about it, the very slow pace of their beginning programs make a lot of sense.
Posted by SLS on April 8, 2006, at 10:33:09
In reply to You just know I have an opinion, right? » SLS, posted by Racer on April 6, 2006, at 12:57:07
Hi Racer.
I'm sorry I didn't get around to responding to your post. All I can say is that you hit the target better than I did.
- Scott> Lucky for you, I don't have time to go into it right now...
>
> Briefly, though, I think there are a couple of factors that are probably coming into play:
>
> 1. CBT probably is part of it, although I'm gonna back away from offering my opinions on that. I'd ask how long after the end of CBT treatment the assessments were done, and I'd look very, very closely at the pre-treatment baseline. Oh, and I'd do another follow up study a year or two later, to see how much LASTING benefit CBT had.
>
> 2. With SSRIs so heavily advertised to consumers, and a few changes in the world that really do affect functioning for a lot of people, I think taking a pill seemed perfectly reasonable to a lot of people for a long time. This is where my longer opinion comes in, but it's basically that a lot of the people on SSRIs in the past decade have really and truly needed non-medication interventions. They needed the things that talk therapy -- actually, more like coaching in life skills -- can provide.
>
> 3. I do think there's a wider range of what's being called depression in these studies. The studies I've read have been pretty consistent on the matter, really: for MILD depression, talk therapy can be as effective as medication. For moderate depression, talk therapy can be pretty helpful, as can medications, but both together are optimal. For severe depression, though, all the studies I've seen have consistently said that medications really are required, but talk therapy can be a very valuable adjunct.
>
> Then again, you know I have opinions... So many, in fact, that I have to give them away to all who'll take them...
Posted by linkadge on April 8, 2006, at 10:54:02
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 7, 2006, at 21:57:18
I would never tell sombody who is benifiting from medications to stop in them in favor of exercise, I am saying that before somebody takes an antidepressant exercise should be tried / and considered for those who aren't responding to drugs as an alternitive or adjunctive.
Linkadge
Posted by linkadge on April 8, 2006, at 10:55:42
In reply to Re: Drugs versus Psychotherapy - Backlash? » linkadge, posted by SLS on April 7, 2006, at 22:14:29
Just because a study design is flawed doesn't imply directly that exercise is innefective. It just means that its effects have not been fully explored.
Linkadge
Posted by SLS on April 8, 2006, at 11:10:15
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 8, 2006, at 10:54:02
> I am saying that before somebody takes an antidepressant exercise should be tried
This is precisely where we are in disagreement.
> and considered for those who aren't responding to drugs as an alternitive or adjunctive.
If one can exercise, I agree that it makes sense to do so.
If you were to prescribe exercise for someone who is severely depressed, how would you administer it? How many weeks do you allow to elapse before declaring it a treatment failure?
- Scott
Posted by SLS on April 8, 2006, at 11:14:07
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 8, 2006, at 10:55:42
> Just because a study design is flawed doesn't imply directly that exercise is innefective. It just means that its effects have not been fully explored.
Properly explored.
In the meantime, people are making critical decisions based upon spurious reports.
- Scott
Posted by linkadge on April 8, 2006, at 13:16:14
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 8, 2006, at 11:10:15
Not everbody with severe depression is low in energy. Severe suicidal depression can exist completely independantly of any psychomotor retardation.
If a person with severe depression was capable of exercise I would recomend trying it first.
Antidepressants have a degree of toxicity and potential for dependance, they can also poop out. Many people with severe unipolar depression don't see results with an antidepressant for a few months anyway.
Remember, we must not start this argument under the assumption that antidepressants work flawlessly.
Linkadge
Posted by linkadge on April 8, 2006, at 13:21:22
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 8, 2006, at 11:14:07
Exercise has not been properly explored or sufficantly explored.
I would say the case for antidepressant usage is also equally spurious. Some drug companies have the full rights to fail eight clinical trials, and get the drug approved based on the questionable and marginal results of the nineth. If thats no spurious, I don't know what is.
Again, we can't start this argument under the assumption that antidepressant drugs work flawlessly. It only makes sence that recovery would be greatly benifit from the usage of the least evasive yet effective treatment. Don't start with a sledghammer when a regular hammer might do, otherwise the regular hammer will never work properly again.
Linkadge
Posted by Phillipa on April 8, 2006, at 13:27:32
In reply to Re: Drugs versus Psychotherapy - Backlash? » Sobriquet Style, posted by SLS on April 8, 2006, at 6:43:10
Scott post your homepage again and then people will see how fit you were when you lifted. You were olympic material and what a hunk but then again you still are. Love Phillipa
Posted by Phillipa on April 8, 2006, at 13:33:38
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Sobriquet Style on April 8, 2006, at 8:01:36
Oh so you're a guy boy these screen names can be deceiving since I'm been in a gym for years I know the different types of training females usually do more reps and at low wts. And females don't gain muscle mass as men do due to hormones. Love Phillipa
Posted by SLS on April 8, 2006, at 14:20:53
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 8, 2006, at 13:16:14
> Not everbody with severe depression is low in energy. Severe suicidal depression can exist completely independantly of any psychomotor retardation.
It is true that agitated depressives have psychomotor activation. These people are probably more at risk for having suicidal ideation. Others are just too anergic, psychomotor retarded, or vegetative to contemplate suicide.
One reason people develop suicidal ideations while taking antidepressants is that they regain enough mental energy to contemplate and plan. This occurs as they begin to respond favorably to treatment, but before they have responded well enough to feel substantially less depressed. It is an irony of sorts. Unfortunately, not enough psychiatrists take this into consideration when they treat people. They don't council patients to be aware of this risk, and they don't monitor patients closely enough during this critical period early in treatment. Of course, some of these drugs can also produce idiosyncratic exacerbations of depression. Just giving patients the insight that these are possible response scenarios would help keep them safe.
> If a person with severe depression was capable of exercise I would recomend trying it first.
I doubt we will agree on this point.
> Antidepressants have a degree of toxicity and potential for dependance,
As do many other types of drugs prescribed for various ailments. Prednisone?
> they can also poop out.
Yes. I know. It is obvious that our current armament of medications is lacking.
Still, you have a better chance of responding robustly to an antidepressant than you do to exercise if you are severely depressed (MDD). This is my contention. I doubt we will agree here.
> Many people with severe unipolar depression don't see results with an antidepressant for a few months anyway.
From what I have seen with the doctors I have worked with, I think this number represents a minority. I think the majority of responders will demonstrate subtle improvements during weeks 3 and 4 of treatment at a therapeutic dosage. I have yet to meet a doctor who routinely uses a rating scale to evaluate the condition of their patients (outside the arena of investigative work). I bet an improvement would become evident earlier in treatment if they were to do so.
> Remember, we must not start this argument under the assumption that antidepressants work flawlessly.Nor do the doctors who prescribe them.
Despite all of my treatment failures, I still believe that, in capable hands, over 75% of MDD people will respond well to the drugs we already have available, especially when used as part of a multimodal approach that may include psychotherapy, nutrition, and even exercise.
- Scott
Posted by SLS on April 8, 2006, at 14:22:48
In reply to Re: Drugs versus Psychotherapy - Backlash? » SLS, posted by Phillipa on April 8, 2006, at 13:27:32
> Scott post your homepage again and then people will see how fit you were when you lifted. You were olympic material and what a hunk but then again you still are. Love Phillipa
Thanks for the warm fuzzies...
- Scott
Posted by linkadge on April 8, 2006, at 16:46:21
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 8, 2006, at 14:20:53
>It is true that agitated depressives have >psychomotor activation. These people are >probably more at risk for having suicidal >ideation. Others are just too anergic, >psychomotor retarded, or vegetative to >contemplate suicide.
Or just people who's depression doesn't impact their energy levels at all. I never really had much psychomotor activation or retardation, it was just inexplicable sadness.
>One reason people develop suicidal ideations >while taking antidepressants is that they regain >enough mental energy to contemplate and plan. >This occurs as they begin to respond favorably >to treatment, but before they have responded >well enough to feel substantially less >depressed. It is an irony of sorts.
Yes, that is one theory as to why suicidiality can increase in the short term. There is also the theory of drug induced akathesia.
>> Antidepressants have a degree of toxicity and potential for dependance,
>As do many other types of drugs prescribed for various ailments. Prednisone?
I guess I mean that if a person could be made well without drug, it would probably make for a better long term outcome. How many people are driven back into dispair when they decide to discontinue their antidepressant?
>Still, you have a better chance of responding >robustly to an antidepressant than you do to >exercise if you are severely depressed (MDD). >This is my contention. I doubt we will agree >here.That one study I showed, the zoloft vs. exercise for MDD, showed a more robust outcome for the exercise group after a few months. I think we simply need more studies to quantify the extent of its potential.
>From what I have seen with the doctors I have >worked with, I think this number represents a >minority. I think the majority of responders >will demonstrate subtle improvements during >weeks 3 and 4 of treatment at a therapeutic >dosage.As one would expect to see some improvements with exercise. After about 3 weeks there was no doubt I was sleeping better.
>Despite all of my treatment failures, I still >believe that, in capable hands, over 75% of MDD >people will respond well to the drugs we already >have available, especially when used as part of >a multimodal approach that may include >psychotherapy, nutrition, and even exercise.
I don't think that drugs are responsible for getting 75% of people better. Clinical trials certainly don't demonstrate this, and even less when you remove possible effect of placebo, and natural recovery. I think their effects are vastly overrated.
Linkadge
Posted by linkadge on April 8, 2006, at 17:02:03
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 8, 2006, at 16:46:21
I think exercise should be recomended in depressed youths where the data seems simultanioulsy suggest lack of effect and increased rates of suicidality.
http://www.newmediaexplorer.org/chris/2004/12/08/the_antidepressant_fraud_no_better_than_placebo.htmLinkadge
Posted by Sobriquet Style on April 8, 2006, at 17:20:01
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by greywolf on April 8, 2006, at 10:24:31
Posted by SLS on April 8, 2006, at 19:01:56
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by linkadge on April 8, 2006, at 16:46:21
> > Despite all of my treatment failures, I still >believe that, in capable hands, over 75% of MDD >people will respond well to the drugs we already >have available, especially when used as part of >a multimodal approach that may include >psychotherapy, nutrition, and even exercise.
> I don't think that drugs are responsible for getting 75% of people better. Clinical trials certainly don't demonstrate this,
What I attempted to convey is that an effective treatment regime can be produced for 75% if one were to use every drug currently available alone or in combination. Very few trials have been designed to study this.
That's 65% using only 3 antidepressants monotherapeutically.
> and even less when you remove possible effect of placebo,
The magnitude of the placebo response varies inversely with the severity of the depression being used as inclusion criteria.
http://ajp.psychiatryonline.org/cgi/content/full/157/3/327
- Scott
Posted by Squiggles on April 8, 2006, at 20:06:05
In reply to Drugs versus Psychotherapy - Backlash?, posted by SLS on April 6, 2006, at 9:43:54
> All of a sudden, psychotherapy is as effective as drug therapy for treating depression!
>
> That's right.
>
> Just look at the medical literature.
>Uhm, which medical literature is that?
> Less than a decade ago, nearly all of the double-blind studies demonstrated a clear advantage to drug therapy over psychotherapy for treating depression.
>
> Now, it is difficult to find such studies. Most of the current literature claims equal effectiveness between the two modes of treatment.
>
> How can this be?Indeed;
>
> Can it be that the emergence of CBT (cognitive behavioral therapy) as the psychotherapeutic treatment of choice has drastically improved the response rate to psychotherapy?Highly unlikely as there is nothing
to improve on - a questionnaire is
a questionnaire is a questionnaire;
>
> Have current investigations defined depression in a different way than they did ten years ago?Possibly;
>
> Have the rating methods or measurement standards that define treatment success changed?Very probable;
>
> Is there a backlash against using drugs to treat depression to be found in the field of psychiatric investigation?Well, maybe doctors are getting sick of
trying 100 more new drugs and have run
out of new diseases to invent;
> A little of all the above?
>
> What's going on?
>
I don't know Scott; I just hope common sense
and knowledge eventually meet at the crossroads
of signs and symptoms in medicine.Squiggles
Posted by linkadge on April 9, 2006, at 9:10:59
In reply to Re: Drugs versus Psychotherapy - Backlash?, posted by SLS on April 8, 2006, at 19:01:56
I can't interprate that last link.
Perhaps placebo responce to drugs goes down as severe depression goes up, but so does responce to active drugs. So this still doesn't determine whether the percentage of placbo responders goes down as sevarity goes up. Perhaps I inteprated incorrectly.
Linkadge
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