APA Releases Guideline For Treating Depression

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.

4 Responses

  1. omg! “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.”

    Doesn’t this remind anyone of another severe treatment for depression/mental disorders…aka lobotomies??? Not only that, in the book “Escape from Babel” by Miller/Duncan/&Hubble the idea that talk therapy was ineffective compared to pharmaceutical therapy was debunked & in fact they have similar success rates for depression/anxiety. As u point out, the pharm/drugs can actually create a manic ep or prolong the problem/disorder & make it worse.

    We are so obsessed with finding a quick solution (electro therapy) rather than focusing on “working” on the problem and actually doing what is best and least potentially damaging to our clients.


    • Totally in agreement with your last paragraph.

      When there has been much controversy about the lack of effectiveness of ssri antidepressants (such pills do no better in clinical trials than enhanced placebos), I find it no wonder that psychotherapy would do as well. Blaming the placebo effect is the other end of this joke. When mental health is restored, must a placebo be credited?

      As for lobotomy as a treatment, the neuroleptic drug that eventually made the lobotomy redundant was initially referred to as a “chemical lobotomy” because doctors were able to get a result very similar to what they saw in patients who had been lobotomized. These drugs have been found to have harmful effects on the brain and body, and their long term use should always be discouraged. Neuroleptic drugs shrink the size of the frontal lobes over time providing essientially the same service as a scapel.

      Obviously conflicts of interest give the APA an agenda that doesn’t serve the best health interests of their patients. First and foremost in importance to them is the matter of selling electroshock as a procedure together with shock devices. Then comes their rather cozy and lucrative relationship with the drug industry. These guidelines end up being about vanity and maintaining a certain lifestyle. When the health of one’s patients comes first, one isn’t so intent on pushing commercial products.

  2. ECT has soooo many side effects- some of which are irreversable memory loss. It suprises me more that it is still seen as a “treatment” and even more that it is being recomended!

    And yes- I recently experienced medication-induced mania. It was such a horrible thing. It is very interesting to me that it has become a chronic illness when it used to not be. It was once considered simply part of the human condition- and now there is this giant stigma.

    And excercise is an absolutely WONDERFUL treatment for depression- but so many people are unwillling! I agree that this entire thing seems to be backwards. These people are obviouly in their own little world that has nothing to do with reality.

    They are only trying to make people dependant on them.

    • I’ve heard people respond with surprize to the fact that ECT is still being done. Some people just don’t know. The American Psychiatric Association would lead people to believe that it is a relatively safe procedure. I would not call any procedure which, as in the case of electroshock, is going to cause some loss of gray matter every time it is performed, safe. Minimizing and downplaying the dangers the way its appolegists do is usually a matter of lying outright. People should be taking to the streets over this issue, and when they do so, I will do my best to be among them.

      Doctors frequently label people sufferers of “major depressive disorder” and then prescribe ssri antidepressants. When the antidepressants trigger a manic reaction, these same doctors will say he or she had been misdiagnosed, Rather than being “unipolarly depressed”, as was initially thought, they will conclude the person has “bipolar disorder”. If the drugs triggered, as it will do in certain percentage of cases, a “manic” reaction, whoa. We’re talking about a drug effect, and it would be better to do something about the antidepressant use than propose another disorder treated by another more powerful and potentially dangerous drug.

      Exercise, there you go! Put a person on a regular regimen of exercise, and then come back to me with the results. If the person is still depressed, we tried. If the person is no longer depressed, we’ve got an evidence based practice. Problem solved. Problem is…drug company money pulls the strings of way too many of these head doctors. They have become very adept at ignoring the evidence.

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