Oh, what an endless treatment quagmire we can get into by qualifying the word depression with the word major. The American Psychiatric Association has just made this quagmire much worse with the release Friday of its “Practice Guideline for Treatment of Patients with Major Depressive Disorder.”
If you’re thinking does this make the prognosis worse for people labeled with major depressive disorder than it may have been in years past, the simple answer to that question is unequivocally yes.
The October 1st Los Angeles Times carried a story on the release of these guidelines, Psychiatrists change their recommendations for depression’s treatment. In this publication, the APA seems to be putting what once might have been regarded as a last resort first. This, I think, should be considered a very distressing development.
For starters, the APA throws its considerable weight behind the rehabilitation of electro-convulsive therapy (a.k.a. “shock therapy”) as an effective recourse for those who fail to respond to antidepressant treatment.
The brain damage produced by electroshock is seen as an effective treatment for the depression of people who fail to respond to antidepressants. I don’t think the doctors have come to the point where they can freely admit to their patients yet that this therapy involves damaging their brains, and then here they are calling the resultant effects of this brain damage therapeutic. When doctors cannot truthfuly tell their patients what the treatment they are receiving entails, consent shouldn’t be considered informed.
The practice guideline ventures to say that for many patients with chronic or recurrent episodes of depression, “maintenance therapy”—including antidepressant medication and possibly ongoing psychotherapy—may need to continue “indefinitely.”
What this practice guideline doesn’t tell you is that “antidepressant medication” usage may be responsible for the chronic nature of some peoples disorder, and the episodic recurrence of its symptoms. Major depression was once thought a disease from which people recovered fairly readily. This view of the disorder has changed over time. It also doesn’t tell you that some of these “antidepressant medications” can trigger mania, and then you get a more severe diagnosis than what you had when you began. Detoxify, and the “symptoms” would stand a better chance of disappearing altogether.
The group that drafted the document, and its steering committee, seem to have divergent views regarding the relative value of talk therapy.
One of the most promising therapeutic answers to major depressive disorder, physical exercise, rather than coming in first on their list of guidelines comes in dead last.
Finally, the association in its latest update bows to the “at least modest” value of physical activity—either aerobic or strength exercises–in relieving symptoms of mood disturbance, and possibly in preventing depression.
Usually we don’t read from the end to the beginning of a document, but I think maybe that would be the best way to approach some of these guidelines being presented by this APA group. Personally, I think they should have started with a non-harmful treatment that had good results, and by good results I don’t mean the forgetfulness and disorientation that comes of a loss of gray matter.