Depression Clinical Research Center?
Q.A classic conflict between science and dogma is brewing in the arena of mental health policy, and its resolution will affect the welfare of millions of Americans who suffer from depression. They will either be consigned to the status quo of current mental health treatment -- the good, the bad and the ugly -- or they will benefit from all that medical research can offer in terms of innovative, high-quality care.
A.a recent study unexpectedly found that antidepressants sometimes perform no better than placebos (sugar pills) in treating depression. On the side of dogma, some claim that this stunning finding does not matter. Well, it does. The study suggests that the "medication only" approach to treating depression may in many cases be mistaken. It may well be that effective psychotherapy -- with or without medication -- should be offered routinely as a primary treatment choice and that further research would shed light on which treatment is best for which person. Congress is considering "mental health parity" legislation that seeks to offer the same coverage for mental illness as is offered for physical illness. And a blue-ribbon= government advisory panel of scientists recently recommended that doctors routinely screen all patients for depression. With these initiatives in place, more Americans will be appropriately diagnosed as suffering from depression, and more will have adequate coverage for treatment. But what should that treatment be? Treatment for depression, as for any mental illness, should consist of the very best science has to offer. Research, especially results-oriented research such as clinical trials, must lead the way to effective care. Khan's findings should not provoke a dogmatic defense of status quo treatments for depression. Instead, they should provoke robust, unbiased follow-up research to determine which treatment is best for which patient. Clearly, many of those struggling with depression respond well to antidepressants. But it also is becoming clear that antidepressants are overprescribed and overly relied upon, and that they should be accompanied more regularly by cognitive psychotherapy (which research has shown to be particularly effective for depression). Other conclusions also may be drawn from the FDA's clinical trials and follow-up research -- conclusions that would improve life for millions with depression. They must not be ignored. But to shrug off uncomfortable scientific findings is to consign people with mental illness to the status quo of our nation's mental health care system. Although many committed mental health professionals are offering useful treatments, the current system of care is in need of sweeping reforms. Too often people with mental illness will receive care that is not effective or will receive no care. This applies to those caught in the vicious cycle of psychiatric hospitalization and homelessness, and it applies to those who see no way out of depression after having tried antidepressants to no avail. The study related to 96 trials referred to above is not in the Medline database, but the following two studies by the same author are. It's important to read what Khan really says. Depression severity is an important co-variable.
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