Date: Tue, 23 Mar 1999 22:29:59 EST
From: Henry Holland <Henry4FDR at AOL.COM>
Subject: Re: [PPM] Sleep Prescription

<< During the past century, while scientists have acquired ever more detailed information about the brain with ever more powerful technologies, there have been virtually no genuine advances in treatments for depression and other common mental disorders. From psychoanalysis to Prozac, all the therapies offered so far are roughly equivalent in their effectiveness, or lack thereof. Roughly two-thirds of patients receiving any form of treatment for depression show some improvement. On the other hand, as many as half of those who don't receive treatment improve anyhow. >>

I think it should be pointed out that the quote from the above article is from the op/ed section of the NY Times, hardly a professional medical journal. The advances in the treatment of biological mental disorders is almost staggering just in my own life time, not to mention comparing to what little was known at the beginning of this century. The SSRI's as antidepressants are compared to the tricyclic antidepressants in research drug studies because the tricyclics have been used effectively for decades. Both groups of antidepressants are effective, but the SSRI's have fewer side effects and thus, compliance is better. Also, death from overdose of SSRI's alone is extremely rare. In fact, I do not know of a proven suicide from an overdose of SSRI's alone. In contrast, an overdose with tricyclics is all too frequently fatal. Thus, there are many reasons that the SSRI's are chosen over the tricyclics as antidepressants.

It is true that psychotherapy provided by a competent and well trained therapist can be effective in treating depression, particularly in a non biological depression. Like many medical conditions, biological depression may not be totally "cured," but can certainly be managed better than fifty years ago. Diabetes, hypertension, various connective tissue disorders, pulmonary disorders, and many other chronic or recurrent conditions are treated with more effectiveness now than fifty years ago. Many conditions may improve as a result of the natural course of the disease. (Polio did just that for many of us after the initial attack was over). During my early years in practice, I knew patients with biological depression and they reported that sometimes a depressive episode would eventually pass during the years when there were no effective treatments for biological depression. These same patients were grateful that effective antidepressant medications became available as their episodes of depression were shortened or often prevented. The result was that many remained employed and were able to be productive citizens despite a biological depressive illness. The same can be said for schizophrenia. Fifty years ago, there were no effective medications for the treatment of schizophrenia. Today, this condition can be managed much better. True, a cure has not been developed, but there is more and more evidence to indicate that this often devastating mental disorder is biological with genetic components.

In my opinion, the article in the NY Times is only presenting one side of this issue. I have simply seen too many patients who have clearly benefited from scientifically based treatment of biologically driven mental (brain) disorders. There is a host of scientific literature to support this claim.

Henry
Dr. Holland is an active member of:
The Central Virginia Post-Polio Support Group

Short Autobiography by Dr. Holland Holland Files On The Lincolnshire Web Site