Re: Stan, , and anti-depressants.

May 13, 2012

Take the happy pils and you might get more than you bargained for. The lack of pleasure in life that PSSD causes if nothing like the anhedonia of depession. Life becomes physically numb, dead boring, and completely pointless, sort of like a world made of carboard. Sounds like depression doesn't it? But PSSD is in another league altogether being an entirely synthetic numbess that is never found in nature. I would much sooner be depressed and have a chance of getting better.

Credit: Getty Images

Some men's libidos never bounce back

Low libido, erectile dysfunction, decreased genital sensitivity, and difficulties reaching orgasm are some of the sexual side effects reported by patients taking SSRIs.Doctors always assumed these problems would resolve themselves once the patient stopped taking the medication, but several small studies—and a growing group of patients—say the effects can continue indefinitely.

http://www.health.com/health/gallery/0,,20431831_6,00.html

Kv

>> First I am very grateful for this thread. And I am stunned. No empirical data? What in the he**?> > Google Dr. Kirsch and you will see he has a lot to say about `no proof' and meds work as well as placebo.> > http://www.reuters.com/article/2008/02/26/us-depression-drugs-idUSN2527622020080226> > "The critical factor is our beliefs about what's going to happen to us. You don't have to rely on drugs to see profound transformation." --Irving Kirsch, psychologist at the University of Connecticut, who attributes the success of Prozac and similar drugs to the placebo effect, New York Times, Jan. 9.> > http://query.nytimes.com/gst/fullpage.html?res=9E00E0DA1330F931A15757C0A9649D8B63 & ref=mentalhealthanddisorders & pagewanted=4> > I think, in addition to 's explanation for why so many have believed that anti-depressants are effective (myself included) has been the, obviously, effective manipulation by the wealthy pharmaceutical companies.> > The timeliness of this information for me is great. I see my psychiatrist next Thursday. Wanda>

May 13, 2012

Hi Kv, have you received any kind of encouraging news about the PSSD going away?

Obviously, I am heading for drug free re: my recent post. And, after years of

drugs, apparently, haven't experienced any 'known' physical damage.

My brother got Tardive Dyskensia from Abilify that he had been on for years. He

was never warned about this. I was perscribed Serequel recently and refused it

because I looked it up and found TD as a possible side effect.

(I doubt I would have understood the seriousness/reality of this 'possible' side

effect if I hadn't seen the horrible, irreversible state my brother is in.) I

hadn't been told about the possible side effect of the Tardive Dyskensia either.

Alot of meds warn of possible sexual side effects, I have never read anything

about PSSD being a possiblity. Wanda

May 13, 2012

I tell fellow sufferers to work at self development, therapy, to engage in life, find happiness, find love, work at mindfulness, etc. If Reuven Feuerstein can heal the badly damaged brains of children, and adults, then we can recover too.

The brain is harmed by cortisol, the stress chemical, which stops it from repairing itself. When we find peace of mind, love, happiness, and contentment, then we are in a good chance of recovery as this will greatly lower cortisol. By these methods we can even repair the cortisol feedback loop which often get stuck high. From what I read, our cortisol levels can get set too high by early childhood events, or even when we are in the womb when our mothers are depressed or anxious, and this predisposes us to depression and anxiety later in life. Plenty of exercise can help to regrow your brain too, as well omega 3 oils, and loving relationships also help. By all these methods we can also reset our genes for happiness by altering our epigenetic gene expression. There is always hope. It's hard work, but well worth it!

Professor Reuven Freuestein say's:

Feuerstein says it is his outlook on life that has led to his achievements. "If you have two alternatives, don't make the pessimistic choice. Always choose like an optimist. At least that will bring you to action, to test the waters. If you take the pessimistic route, you'll never accomplish anything. Even if you don't think you'll reach the highest levels, you still have to try to climb up."

P. Reuven Freuestein:

http://www.aish.com/jw/id/48914587.html

Kv

>> > > Hi Kv, have you received any kind of encouraging news about the PSSD going away? > > Obviously, I am heading for drug free re: my recent post. And, after years of drugs, apparently, haven't experienced any 'known' physical damage. > > My brother got Tardive Dyskensia from Abilify that he had been on for years. He was never warned about this. I was perscribed Serequel recently and refused it because I looked it up and found TD as a possible side effect.> > (I doubt I would have understood the seriousness/reality of this 'possible' side effect if I hadn't seen the horrible, irreversible state my brother is in.) I hadn't been told about the possible side effect of the Tardive Dyskensia either. > > Alot of meds warn of possible sexual side effects, I have never read anything about PSSD being a possiblity. Wanda>

May 13, 2012

Oh, I should have said Professor Reuven Freuestein uses therapy, self

development, and special exercise/ games, to repair the damaged brains

of his patients. He is not a brain surgeon.

It not about whether these drugs should be used or not: people with

severe depression need all the help they can get. But they shoud only be

used wisely for short periods of time for people that they have shown to

help, i.e, those with the most severe depressions. For everyone else

they seem to act purely as placebos, so therapy is the safer option. I

too experienced the antidepressant effects from these drugs, but it only

lasted a week. Still, I reckon that's enough to get someone over a nasty

period. Right now I could really do with some medical help, but those

drugs are far too toxic for me. But I can undestand why other people use

them.

My anger is not with folk who use these drugs, but with psychaitry who

totally misunderstood what I needed to get better.

Kv

> >

> > Hi Kv, have you received any kind of encouraging news about the PSSD

> going away?

> >

> > Obviously, I am heading for drug free re: my recent post. And, after

> years of drugs, apparently, haven't experienced any 'known' physical

> damage.

> >

> > My brother got Tardive Dyskensia from Abilify that he had been on

for

> years. He was never warned about this. I was perscribed Serequel

> recently and refused it because I looked it up and found TD as a

> possible side effect.

> >

> > (I doubt I would have understood the seriousness/reality of this

> 'possible' side effect if I hadn't seen the horrible, irreversible

state

> my brother is in.) I hadn't been told about the possible side effect

of

> the Tardive Dyskensia either.

> >

> > Alot of meds warn of possible sexual side effects, I have never read

> anything about PSSD being a possiblity. Wanda

> >

>

May 13, 2012

Very interesting. May I offer a post in the spirit of playful curiosity, and not intended to light any fuses. It is very easy to criticise the evidence base to support anti-depressants, which I think is very sensible when mulling over what is quite an important decision. It is also very popular - there's nothing like giving a large faceless and insanely profitable industry a good kicking to give us all a feel-good factor!!! I offer the idea that the evidence to support talking therapies isn't perfect either. I am very happy to be corrected if I am talking nonsense! (1) Drugs undoubtedly have a placebo effect,

and drugs trials should ensure that any measured benefits of a drug are over-and-above that reported by those who in the placebo arm of the trial. I don't see why therapies can't suffer from placebo effects too? Maybe the benefit of CBT etc is largely through human contact with a therapist, and getting out of the house, and nothing to do with the theapeutic work. Maybe we spend our money on coffee mornings rather than CBT! (2) How do CBT / ACT trials "blind" their studies, like drugs trials do? Drugs trials blind both the patient (to whether they get the drug or the placebo) and the doctor (as to which they have dispensed). Without this: (i) the participant in the trial may well overstate the benefits of therapy knowing that this is what the evaluators want to

hear; and (ii) the therapist may well (deliberately, or sub-consciously) put in special effort over-and-above what is in the therapy protocol in order to maximise the positives in the trial (or, theoretically, unintentionally put in fewer efforts into cases not part of the trial) (3) Therapists earn money from their wares just like drugs companies. I've read self-help books based on CBT that make false promises that make the claims of drug companies pale in comparison. I have read self-help books that have shamelessly been very selective with the evidence they quote. We like to think that therapists are on a morally superior plane to pharmaceutical companies, but we cannot rule out the conflict of interest. (4) Can therapy have side-effects too? I think it is

certainly feasible that patients can become (psychologically) dependent on their therapist, and suffer from withdrawal symptoms (sometimes relapsing) when they are disharched from their care. Are trials of therapies as alert as drugs trials to unforseen outcomes? Like I say, just being curious. x To: ACT_for_the_Public

Sent: Sunday, 13 May 2012, 15:27 Subject: Stan, , and anti-depressants.

First I am very grateful for this thread. And I am stunned. No empirical data? What in the he**?

Google Dr. Kirsch and you will see he has a lot to say about `no proof' and meds work as well as placebo.

http://www.reuters.com/article/2008/02/26/us-depression-drugs-idUSN2527622020080226

"The critical factor is our beliefs about what's going to happen to us. You don't have to rely on drugs to see profound transformation." --Irving Kirsch, psychologist at the University of Connecticut, who attributes the success of Prozac and similar drugs to the placebo effect, New York Times, Jan. 9.

http://query.nytimes.com/gst/fullpage.html?res=9E00E0DA1330F931A15757C0A9649D8B63 & ref=mentalhealthanddisorders & pagewanted=4

I think, in addition to 's explanation for why so many have believed that anti-depressants are effective (myself included) has been the, obviously, effective manipulation by the wealthy pharmaceutical companies.

The timeliness of this information for me is great. I see my psychiatrist next Thursday. Wanda

May 13, 2012

When you are numb with depression it is painful, but when you are numb

with PSSD it is like everything is made of polystyrene. It feels so odd.

Kv

> >

> > First I am very grateful for this thread. And I am stunned. No

> empirical data? What in the he**?

> >

> > Google Dr. Kirsch and you will see he has a lot to say about `no

> proof' and meds work as well as placebo.

> >

>

http://www.reuters.com/article/2008/02/26/us-depression-drugs-idUSN25276\

\

> 22020080226

> >

> > " The critical factor is our beliefs about what's going to happen to

> us. You don't have to rely on drugs to see profound transformation. "

> --Irving Kirsch, psychologist at the University of Connecticut, who

> attributes the success of Prozac and similar drugs to the placebo

> effect, New York Times, Jan. 9.

> >

>

http://query.nytimes.com/gst/fullpage.html?res=9E00E0DA1330F931A15757C0A\

\

> 9649D8B63 & ref=mentalhealthanddisorders & pagewanted=4

> >

> > I think, in addition to 's explanation for why so many have

> believed that anti-depressants are effective (myself included) has

been

> the, obviously, effective manipulation by the wealthy pharmaceutical

> companies.

> >

> > The timeliness of this information for me is great. I see my

> psychiatrist next Thursday. Wanda

> >

>

May 13, 2012

Hi , no fuses lit here.

I appreciate how clearly you stated the questions.

I am starting a year long program in dialectical behavior therapy. There are

those who claim there is empirical proof that DBT works.

I was Googling to find out how this was possible, vis a vis your questions.

And I found a paper written by about that very question!

I haven't read it yet; I am just so excited to have found it I wanted to post

about it. Wanda

http://www.drluoma.com/ACT_FAP_%26_DBT_review.pdf

-

May 13, 2012

I am so glad I got over my SSRI addiction a month ago. Was on paroxitine since 2007, had experienced withdrawal a couple of times when I forgot to take which lead me to fear discontinuation. I wasn't informed of danger when prescribed but quitted because I realized it ain't helping much after initial optimism, I still relapsed into major depression and substance abuse.I believe the better way to neurological alteration is through psychological intervention, rather than "short-cut" mentality persuaded by pharmaceutical industry.The only way to get rid of weed is removing it's root, not plucking it's leaves.LOVEACT> >> > First I am very grateful for this thread. And I am stunned. No> empirical data? What in the he**?> >> > Google Dr. Kirsch and you will see he has a lot to say about `no> proof' and meds work as well as placebo.> >> >> http://www.reuters.com/article/2008/02/26/us-depression-drugs-idUSN25276\> 22020080226> >> > "The critical factor is our beliefs about what's going to happen to> us. You don't have to rely on drugs to see profound transformation."> --Irving Kirsch, psychologist at the University of Connecticut, who> attributes the success of Prozac and similar drugs to the placebo> effect, New York Times, Jan. 9.> >> >> http://query.nytimes.com/gst/fullpage.html?res=9E00E0DA1330F931A15757C0A\> 9649D8B63 & ref=mentalhealthanddisorders & pagewanted=4> >> > I think, in addition to 's explanation for why so many have> believed that anti-depressants are effective (myself included) has been> the, obviously, effective manipulation by the wealthy pharmaceutical> companies.> >> > The timeliness of this information for me is great. I see my> psychiatrist next Thursday. Wanda> >>

May 13, 2012

Reactions to 's great post are below C. Foundation ProfessorDepartment of Psychology /298University of NevadaReno, NV 89557-0062 " Love isn't everything, it's the only thing "

Very interesting. May I offer a post in the spirit of playful curiosity, and not intended to light any fuses.

It is very easy to criticise the evidence base to support anti-depressants, which I think is very sensible when mulling over what is quite an important decision. It is also very popular - there's nothing like giving a large faceless and insanely profitable industry a good kicking to give us all a feel-good factor!!!

I offer the idea that the evidence to support talking therapies isn't perfect either. I am very happy to be corrected if I am talking nonsense!

(1) Drugs undoubtedly have a placebo effect,

and drugs trials should ensure that any measured benefits of a drug are over-and-above that reported by those who in the placebo arm of the trial. I don't see why therapies can't suffer from placebo effects too? Maybe the benefit of CBT etc is largely through human contact with a therapist, and getting out of the house, and nothing to do with the theapeutic work. Maybe we spend our money on coffee mornings rather than CBT!

The placebo effect applies to psychotherapy too ... except as you dig through it " placebo " expands and gradually blends into a variety of social influence processes.

In a way, it grows and ends up on a continuum with therapy itself.In drug trials you can greatly limit the placebo (perhaps just down to the belief you aretaking a medication that can help).

You can't do that well with psychotherapy -- not because the issues is gone but because it gets biggerwith social interaction methods.It gets so big the question changes to this one: why do people improve:

e.g. You mentioned human contactand getting out the housebut it would include believing it will help,having a credible plan, liking our therapists,feeling liked by your therapist, having an understanding why things are not going well,

agreeing with you therapist about that understanding,

etc etc These are what is meant by " general factors " So the question changes from " is this better than placebo " to

to " is the improvement due to general factors only " (you have to say " only " because you know

before hand all these things help) " or is change also due to specific factors changed by therapy? " (e.g., in

ACT: changes in experiential avoidance, clarify of chosen values, defusion,present moment focus etc).These are very hard questions to ask ... but you can do it.

If you dig into literature like the stuff around ACT that effort isa big chunk of it. You do book studies (taking out the relationship),you add controls; you assess for credibility etc etc

And therapy researchers disagree. Read the critical articles onACT and that is what they are saying ( " this could be due to x, y, or z " ).One thing we have a tradition of inside ACT is if you criticize us responsibly,

we invite you to come talk to us. I cannot think of a single major critic who has notbeen invited ... not all can come but almost every year major critics do come.Sometimes they beat the heck out of us (on our nickel).

It is not that we like criticism emotionally (we don't) - it is thatit is so good for us to hear. This year for example Craske is one of our headliners.But she wrote a really good debunking article a while back that essentially claimed that ACT is not

that new. We want her to come -- she's a very,very solid scientist and she will help usjust by being honest and clear with us. We may or may not agree ... but wewill be better because of her knowledge, either way.

(2) How do CBT / ACT trials " blind " their studies, like drugs trials do? Drugs trials blind both the patient (to whether they get the drug or the placebo) and the doctor (as to which they have dispensed). Without this:

(i) the participant in the trial may well overstate the benefits of therapy knowing that this is what the evaluators want to

hear; and (ii) the therapist may well (deliberately, or sub-consciously) put in special effort over-and-above what is in the therapy protocol in order to maximise the positives in the trial (or, theoretically, unintentionally put in fewer efforts into cases not part of the trial)

Great issues.Before we get into what you can try to do with them though, we need tonote that all is not well in double-blind land.

Although all good psychoactive drug studies " blind " the patients, there is a problem there.Psychoactive drugs create side effects (dry mouth etc).The vast proportion of drug studies use inert placebos without side effects

(e.g., sugar pills). Bad idea. 80% or more of the patients know which condition they are in.They have " broken the blind. " The solution is to measure that, adjust for it statistically, and use active placebos,

(things like antihistamines that have side effects

like dry mouth that you can warn about but are known to be inert). Why that is not done: It is not required by the FDA and if you use an " active " placebo, the effects go way down.

That is not good if you aretrying to get the FDA to say you can sell things worth billions to your company. " Effect size " is a way of measuring the difference

between the treatment and placebo groups.In Kirsch's initial review of anti-depressants there were a handful of such studies(ones that used active placebos)and the effect size he argued was approximately zero.

That is one way we know anti-depressants have a serious placebo component to them.Now unfortunately, big Pharma hates active placebos and avoids them like the plague.

I think they should be required before a drug is recognized as effectivebut FDA does not agree. Yet.And frankly I cannot help but believe that the system is tilted because the money is so huge.

Remember the tobacco emails? When they were forced out of big tobacco, welearned that they really were plotting how to addict children with Joe Camel ads etc.That is why the tobacco settlement exists.

Tobacco is nothin compared to medications. The mark up can be beyond belief.A drug off patent that you get for $4 a month might be $250 a month the day before it goes offpatent. Do the math

The frustrating this is that although these methodological problems are known and solvablethere is no interest in solving it within the industry itself. Somehow normal people seem to lose their minds.

We had a major psychoactive drug researcher (with big pharma consultancies a mile long ...that is, with a big chunk of his wallet on the table) speak at our University several years back.

I ask him in the Q and A after a talk how we could trust the anti-depressant literaturewhen active placebos are almost never used and penetration of the blind is generally not used(all the issues that Irving Kirsch on others eventually forced onto the table).

" Like what instead " he asks. " Well, antihistamines " sez I. " That would be unethical .. they have side effects " sez he.You have to appreciate the boldness, but I almost swallowed my tongue.

Anyone can go buy Benadryl (diphenhydramine) in the grocery store.Children can buy it.Yes, it has side effects (that is why it is a good active placebo!).

It creates dry mouth, nose, and throat; drowsiness; dizziness; nausea; vomiting; loss of appetite; constipation; increased chest congestion;headache; muscle weakness; excitement (especially in children); and

nervousness (sounds like those lists on the TV commercials for various drugs and that is exactly the point!).Now it is true that it can produce side effects that may be serious (e.g.,

vision problems or painful urination can indicate a serious reaction ...as you will see if you read the Benadryl box), but the reason you can buy it without aprescription is that these are very rare and readily manageable.

You manage the side effect risks in drug trial by telling people " you may have ____ " but these are minor, however " if you get _[serious effects]___ " let us know right away.

They do that now in these studies but the list is only likely to occurif you get the active drug! And the serious side effects areusually much, much longer than Benadryl

Think of what a load of pony poop this is.It is unethical to give an over the counter medication as a controlbut it is ethical to do studies that almost everyone can figure out

who in getting an actual drug, and oh by the way, thesedrugs have huge side effects lists that can go all the way up to and including suicide risk. Aaaagh.Then think of the methodological problem.

When you give that side effect list that the ethics committee told you isa required part of informed consent you might as well just say " here is how to know if you are on the active drug condition "

and then give the list. So assume blind doesn't mean blind ... unless the control condition produces effectsthat are also on the list. And 99% of the time that isn't the case

Sigh. Heavy sigh.I believe in medications. I just don't believe in crap science as the basis ofdetermining if they are safe and effective

Still, to return to your issue (i.e., psychotherapists have the same problem)They do. And then someYou can't blind the clients and therapists fully since a client can't do therapy

not knowing what therapy he or she is getting ... by definition.So the methodological problem is much harder to solve.

First, you can blind assessment. If you are doing clinical ratingsuse raters other than the therapists; blind the raters (they don't know which conditionfolks were in). If you are taking self-report make clear that the therapists will not see the data.

To avoid people just saying nice things, use lots of objective measures(e.g., assess smoking by CO content, not people checking the " I don't smoke anymore " box; etc etc)

To control for therapist buy inYou can use therapists and supervisors who believe in the alternative

treatment; etcTo control for credibility (etc) measure it early in RxThe list goes on and on. it is way hard to do. Drug trials too (I've done both).

There are good ACT trials with these bells and whistles and ACT still worked. Not many (they are expensive)and it is true that effects tend to go down the bigger and better the study

in all psychotherapy methods (showing that what is worried about is a realissue)

(3) Therapists earn money from their wares just like drugs companies. I've read self-help books based on CBT that make false promises that make the claims of drug companies pale in comparison. I have read self-help books that have shamelessly been very selective with the evidence they quote. We like to think that therapists are on a morally superior plane to pharmaceutical companies, but we cannot rule out the conflict of interest.

You betcha. Some of it is loathsomely bad and there is a conflict of interest.Things we did in the ACT universe to try to diminish it a bit

(sorry if this sound like self-praise -- my point is to show how seriouslywe take that issue)we opened up the approach to anyone

(you can register on the website and get almost anything for free);we allowed people to name it what they wanted to (there are more than a dozen names forACT or ACTish work);

we swore off certifying therapists

(gives too much power to developers); we recognize trainers but it is done by peer review, not by developers, and no money changes hands;trainers have to promise not to make proprietary claims and to make

their protocols available for low cost or no cost;we set up a process at willing publishers to make sure the claims for ACT books are reasonable and are data based;

books are submitted to

outside agencies, like the Association for Behavior and Cognitive Therapies,

for evaluation (some have seals of approval from that process ... Get Out of Your Mindor Mindfulness for Two, for example);we do studies on the self help books (e.g., this one:

Muto, T., , S. C., & Jeffcoat, T. (2011). The effectiveness of

Acceptance and Commitment Therapy bibliotherapy for enhancing the psychological

health of Japanese college students living abroad. Behavior Therapy, 42, 323–335. Doi: 10.1016/j.beth.2010.08.009);

we cooperate with other research teams who want to test ACT against their methods

we invite critics to our meetings

we have a section on the website anyone can add to on our empirical failures

All of that helps, but the issues remain. You can see just in the length of the

list how seriously we take it ... but its a constant struggle

(even with yourself).

For example, although ACT has had spectacularsuccesses and has regularly beaten even traditional CBT (which is a very

useful approach -- the gold standard in most areas), a few weeks ago a new study found slightly better depression outcomes for CBT

at a 2 year follow up. Three other studies have found the opposite.So now we have contradictory evidence ... and have to figure out why it happened.

That's really hard to do and it is emotionally hard to face data like that

I mention it even here on purpose (though I know it will not be great to hear). My point is that ACT is not a panacea. It is not a guarantee.

It is not a sales job.It is an intervention approach linked to a scientific and clinical development community.

Ya wanna guarantee, go to Sears and buy a washing machine.What ACT " guarantees " is we are doing our best to build an open, honest, transparent, non-horizontal, effective,

development community that is more focused on people than on moneyor pride. As best we can. Which is not perfect. But we will keep trying to do it better.

Whew

(4) Can therapy have side-effects too? I think it is

certainly feasible that patients can become (psychologically) dependent on their therapist, and suffer from withdrawal symptoms (sometimes relapsing) when they are disharched from their care. Are trials of therapies as alert as drugs trials to unforseen outcomes?

It is a known effect. That is why you want long term follow ups; and you fight to get the data on ALL patients;and you analyze ALL patients as best you can.

A postiive exampleWe did a study that found that ACT was helpful in coping with hallucinations and delusionsand keeping them out of the hospital over the 4 month we monitored them.

This is the study

Bach, P. & , S. C. (2002). The use

of Acceptance and Commitment Therapy to prevent the rehospitalization of

psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70 (5), 1129-1139.

Doi: 10.1037//0022-006X.70.5.1129

About 2 years ago Jim Coyne, a science critic at a major University in a blog for Psychology Today just ripped us because in the study subjects died and a couple more when to jail (in both groups) and a few left town but they were not included in the re-hospitalization data.

(You can Google his Psych Today blog if you want ... it will make your hair curl! It's strong ... almost says we are frauds etc]What we dida) breath in. breath out.

I emailed Jim to get clearer on his criticismsc) we redid the analysis. If people died or went to jail we set that day as if the person have been rehospitalized.

and we imputed missing data (a complicated statistical procedure to adjust for missing data). We added 1 year follow up data.Then we published these new data:

Bach, P., Gaudiano, B. A., , S. C. &

Herbert, J. D. (in press). Acceptance and Commitment Therapy for psychosis: Intent

to treat hospitalization outcome and mediation by believability. Psychosis.

Bach, P., , S. C. & Gallop, R.

(2012). Long term effects of brief Acceptance and Commitment Therapy for psychosis.

Behavior Modification, 36, 167 - 183.

Doi: 10.1177/0145445511427193So now, thanks to Jim kicking our butts (rightly) we know more. A lot more.

d) I invited Jim to our next conference (it did not work out but maybe in the future)

There is a bit of pride in this post. Forgive me for that ... to be honest the " pride " covers over the 100 ways I know

we have not yet been up to the hard work of doing good science.

So let me give you a negative example (maybe)

I think I see a pattern in the ACT datain which people who are doing really well, thank you very much, may actually do WORSE

if they go into an ACT treatment condition. It is just a couple of studies (not clinical treatment studies ...

obvious there people are not doing well or they do not get in), the effect is small, and it has never been statistically reliable yetbut I'm a little bit worried. It might be there

There is your issue ... exactly that

So now I'm looking for it. If it is real I think what is happening is that

people who are well defended start seeing hard places and it disregulates them.If that is real we have to build something for these folks. We cannot just ignore it

So you have a great issue. We are watching out for it ... and most good

psych researchers would. But it is hard

Sorry for the crazy long email gang. DK why I did that today ... avoidingwork I'd guess

: )

Peace, love, and life to all

- S

Like I say, just being curious. x

To: ACT_for_the_Public

Sent: Sunday, 13 May 2012, 15:27 Subject: Stan, , and anti-depressants.

First I am very grateful for this thread. And I am stunned. No empirical data? What in the he**?

Google Dr. Kirsch and you will see he has a lot to say about `no proof' and meds work as well as placebo.

http://www.reuters.com/article/2008/02/26/us-depression-drugs-idUSN2527622020080226

" The critical factor is our beliefs about what's going to happen to us. You don't have to rely on drugs to see profound transformation. " --Irving Kirsch, psychologist at the University of Connecticut, who attributes the success of Prozac and similar drugs to the placebo effect, New York Times, Jan. 9.

http://query.nytimes.com/gst/fullpage.html?res=9E00E0DA1330F931A15757C0A9649D8B63 & ref=mentalhealthanddisorders & pagewanted=4

I think, in addition to 's explanation for why so many have believed that anti-depressants are effective (myself included) has been the, obviously, effective manipulation by the wealthy pharmaceutical companies.

The timeliness of this information for me is great. I see my psychiatrist next Thursday. Wanda

May 14, 2012

A thoroughly enjoyable and fascinating read, thank you for taking the time to go through this. Not everyone will be interested, but I felt an important topic to raise.The biggest concern I had was implicit across each of the questions I posed: namely, that we appear on this forum to demand a higher standard of evidence from drug research than we do of psychology research. That we are quicker to be cynical of the former, and too beguiled in our acceptance of the latter. That our 'curious scientist' within us should be more even-handed.Readers of your reply will be clear that there is no complacency in the science of ACT, and you are right to have the upmost pride in that

fact.Best wishes, x To: ACT_for_the_Public Sent: Monday, 14 May 2012, 4:09 Subject: Re: Stan, , and anti-depressants.

Reactions to 's great post are below C. Foundation ProfessorDepartment of Psychology /298University of NevadaReno, NV 89557-0062"Love isn't everything, it's the only thing"

Very interesting. May I offer a post in the spirit of playful curiosity, and not intended to light any fuses.

It is very easy to criticise the evidence base to support anti-depressants, which I think is very sensible when mulling over what is quite an important decision. It is also very popular - there's nothing like giving a large faceless and insanely profitable industry a good kicking to give us all a feel-good factor!!!

I offer the idea that the evidence to support talking therapies isn't perfect either. I am very happy to be corrected if I am talking nonsense!

(1) Drugs undoubtedly have a placebo effect,

and drugs trials should ensure that any measured benefits of a drug are over-and-above that reported by those who in the placebo arm of the trial. I don't see why therapies can't suffer from placebo effects too? Maybe the benefit of CBT etc is largely through human contact with a therapist, and getting out of the house, and nothing to do with the theapeutic work. Maybe we spend our money on coffee mornings rather than CBT!

The placebo effect applies to psychotherapy too ... except as you dig through it "placebo"expands and gradually blends into a variety of social influence processes.

In a way, it grows and ends up on a continuum with therapy itself.In drug trials you can greatly limit the placebo (perhaps just down to the belief you aretaking a medication that can help).

You can't do that well with psychotherapy -- not because the issues is gone but because it gets biggerwith social interaction methods.It gets so big the question changes to this one: why do people improve:

e.g. You mentioned human contactand getting out the housebut it would include believing it will help,having a credible plan, liking our therapists,feeling liked by your therapist, having an understanding why things are not going well,

agreeing with you therapist about that understanding,

etc etc These are what is meant by "general factors" So the question changes from"is this better than placebo" to

to "is the improvement due to general factors only" (you have to say "only" because you know

before hand all these things help) "or is change also due to specific factors changed by therapy?" (e.g., in

ACT: changes in experiential avoidance, clarify of chosen values, defusion,present moment focus etc).These are very hard questions to ask ... but you can do it.

If you dig into literature like the stuff around ACT that effort isa big chunk of it. You do book studies (taking out the relationship),you add controls; you assess for credibility etc etc

And therapy researchers disagree. Read the critical articles onACT and that is what they are saying ("this could be due to x, y, or z").One thing we have a tradition of inside ACT is if you criticize us responsibly,

we invite you to come talk to us. I cannot think of a single major critic who has notbeen invited ... not all can come but almost every year major critics do come.Sometimes they beat the heck out of us (on our nickel).

It is not that we like criticism emotionally (we don't) - it is thatit is so good for us to hear. This year for example Craske is one of our headliners.But she wrote a really good debunking article a while back that essentially claimed that ACT is not

that new. We want her to come -- she's a very,very solid scientist and she will help usjust by being honest and clear with us. We may or may not agree ... but wewill be better because of her knowledge, either way.

(2) How do CBT / ACT trials "blind" their studies, like drugs trials do? Drugs trials blind both the patient (to whether they get the drug or the placebo) and the doctor (as to which they have dispensed). Without this:

(i) the participant in the trial may well overstate the benefits of therapy knowing that this is what the evaluators want to

hear; and (ii) the therapist may well (deliberately, or sub-consciously) put in special effort over-and-above what is in the therapy protocol in order to maximise the positives in the trial (or, theoretically, unintentionally put in fewer efforts into cases not part of the trial)

Great issues.Before we get into what you can try to do with them though, we need tonote that all is not well in double-blind land.

Although all good psychoactive drug studies "blind" the patients, there is a problem there.Psychoactive drugs create side effects (dry mouth etc).The vast proportion of drug studies use inert placebos without side effects

(e.g., sugar pills). Bad idea. 80% or more of the patients know which condition they are in.They have "broken the blind."The solution is to measure that, adjust for it statistically, and use active placebos,

(things like antihistamines that have side effects

like dry mouth that you can warn about but are known to be inert). Why that is not done: It is not required by the FDA and if you use an "active" placebo, the effects go way down.

That is not good if you aretrying to get the FDA to say you can sell things worth billions to your company."Effect size" is a way of measuring the difference