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Plot summary:<\/font><\/strong><\/u><\/a> The life of spoiled Robert Merrick is saved through the use of a hospital’s only pulmotor, but because the medical device cannot be in two places at once, it results in the death of Dr. Hudson, a selfless, brilliant surgeon and generous philanthropist. Merrick falls in love with Hudson’s widow, Helen, though she holds him responsible for her husband’s demise. One day, he insists on driving her home and makes a pass at her. She gets out and is struck by another car, losing her sight. He watches over her and visits her during her recuperation, concealing his identity and calling himself Dr. Robert. When he finds out that she is nearly penniless, he secretly pays for specialists to try to restore her vision. Finally, she travels to Paris and is told that her eyesight is gone forever. Robert follows her, confesses his true identity and proposes marriage. She forgives him, but goes away, not wanting to be a burden to him. Years later, Robert has become a brain surgeon. He learns that Helen urgently needs an operation, which he performs. When she awakens, her sight has miraculously returned.<\/font><\/em><\/sup><\/td>\n<\/tr>\n<\/table>\nThose were the days when the big screen could resolve any tragedy into a triumph of the the human spirit – as in Lloyd C. Douglas’ 1935 Magnificent Obsession<\/font><\/strong>. We know this theme best from Scarlett’s 1939 soliloquy, "Tomorrow is another day!" in Gone with the Wind<\/font><\/strong>. We’d moved a long way from the Greek Tragedies or Shakespeare where tragic character flaws lead to inevitable ruin. The 1930s were a time when the themes of redemption in the cinema offered temporary respit from the terror and hardship of the Depression, the inklings of the coming War. But in practice, an obsession only becomes magnificent if it prevails against all odds. Otherwise, it’s just an obsession – clinging to an idea well beyond the time when the evidence has clearly negated any chance of success. <\/p>\n Which logically brings us to the story of the modern antidepressants [SSRIs, Bupropion, and SNRIs]. Eli Lilly’s Prozac<\/font><\/strong> came on the scene in 1987, around the time I was beginning a private practice. We all remember the excitement of the time. The tricyclic antidepressants had been around for a long time and most of us thought of them as treatment for the severe depressions. Although the DSM-III had thrown those syndromes into the wastebasket of Major Depressive Disorder, we still remembered their names [Melancholia, Involutional Depression, Post-partum Depression, etc.] and still used the terms [because the patients were still there in spite of their un-naming<\/em>]. But the tricyclics were, at best, only maybe<\/em> drugs in the more common depressed patients we saw. Prozac changed all of that, followed by an army of me-too<\/em> antidepressants. In short order, all<\/u> Depressions were Major Depressive Disorders, and the<\/u> treatment for Major Depressive Disorder became the antidepressant du jour<\/em>. In a more subtle way, depression itself became biology<\/em>, neuroscience<\/em>, chemical imbalance<\/em>. Prior to that, the consensus had been that many of the severe depressive syndromes were biologic<\/em>, but that moniker was extended to all<\/u> depression after the coming of Prozac and friend.<\/p>\n As cracks began to appear in House SSRI<\/font><\/strong>, there was a concerted effort to un-see<\/em> them [matching the persistent un-naming<\/em> of the classic depressive syndromes]. Decreased libido, erectile dysfunction, anorgasmia, akisthisia, suicidal thinking, withdrawal syndromes – one by one, they were resisted vigorously as they appeared by both the pharmaceutical industry and their psychiatric Key Opinion Leaders – a story you know all too well. But then the foundation began to crack as well when the efficacy itself came into question. It came slowly. "They don’t work as well as we’d like" became "they don’t work very well" on the way to "Do they even work at all?" To the clinical neuroscientists who had put all of their eggs in that basket, that was an intolerable progression. Thus was born the magnificent obsession<\/font><\/strong> that these hallowed medications just had to work – maybe they were just being given in the wrong way; maybe they needed to be augmented, sequenced, or combined; maybe there’s a biosignature that will predict who will respond. <\/p>\n Clinician-rated symptom measures, while time-consuming, provide a firm basis for making strategic [e.g., switching or augmenting treatment] or tactical [e.g., dose adjustments, starting side effect treatments, etc.] decisions. Thus, the routine use of clinical rating scales seems justified. <\/p>\n <\/sup><\/ul>\n So in the 16 years since publishing the Treatment of Depression to Remission<\/font><\/strong><\/u>, Rush and Trivedi masterminded four major implementations of their concept of measurement-based<\/em> care using sequencing algorithms<\/em> or combination therapy<\/em> aiming for remission<\/em> [TMAP<\/font><\/strong>, STAR*D<\/font><\/strong>, IMPACTS<\/font><\/strong>, CO-MED<\/font><\/strong>]. All four studies were government financed [expensive undertakings]. One was part of a huge pharmaceutical fraud. All four were failed studies. Rarely mentioned is the fact that the algorithms themselves were all arbitrary sequences created by the authors based on… I don’t know what they were based on<\/em>. One might have thought that they had amassed enough evidence to conclude that measurement-based<\/em>, evidence-based,, remission-bound<\/em>, algorithmic<\/em> treatment wasn’t working out so well after all. And these studies spanned a period when there was a growing consensus that the antidepressants were much less efficacious and more toxic than advertised – by anyone’s measure.<\/p>\n <\/p>\n <\/sup><\/ul>\n <\/p>\n <\/p>\n<\/p>\n
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by Rush AJ<\/font><\/strong>, Kraemer HC, Sackeim HA, Fava M, Trivedi MH<\/font><\/strong>, Frank E, Ninan PT, Thase ME, Gelenberg AJ, Kupfer DJ<\/font><\/strong>, Regier DA<\/font><\/strong>, Rosenbaum JF, Ray O, and Schatzberg AF; ACNP Task Force.<\/sup>
Neuropsychopharmacology<\/font><\/strong>. 2006 Sep;31(9):1841-53.
[full text on-line<\/font><\/strong><\/u><\/a>]<\/div>\n <\/p>\n
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by Morris DW and, Trivedi MH<\/font><\/strong><\/sup>
Current Psychiatry Report<\/font><\/strong>. 2011 13(6):446-58.<\/p>\n\n
by Shelton RC and Trivedi MH<\/font><\/strong><\/sup>
Journal of Clinical Psychiatry<\/font><\/strong>. 2011 72(9):e29.<\/div>\n\n
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