{"id":31408,"date":"2012-12-27T19:59:58","date_gmt":"2012-12-28T00:59:58","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=31408"},"modified":"2012-12-27T22:01:26","modified_gmt":"2012-12-28T03:01:26","slug":"kind-of-embarrassing","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/12\/27\/kind-of-embarrassing\/","title":{"rendered":"kind of embarrassing&#8230;"},"content":{"rendered":"<div align=\"justify\">The recent article in the Washington Post deserves reading, but you probably know everything it has to say. Here&#8217;s a simple point:          <\/div>\n<blockquote>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.washingtonpost.com\/business\/economy\/antidepressants-to-treat-grief-psychiatry-panelists-with-ties-to-drug-industry-say-yes\/2012\/12\/26\/ca09cde6-3d60-11e2-ae43-cf491b837f7b_story.html\">Antidepressants to treat grief? Psychiatry panelists with ties to drug industry say yes<\/a><br \/>               <strong><font color=\"#200020\">Washington Post with Bloomberg<\/font><\/strong><br \/>               By Peter Whoriskey<br \/>               December 26, 2012<\/div>\n<p align=\"justify\"><sup><strong>It was a simple experiment in healing the bereaved: Twenty-two patients who had recently lost a spouse were given a widely used antidepressant. The drug, marketed as Wellbutrin, improved &ldquo;major depressive symptoms occurring shortly after the loss of a loved one,&rdquo; the report in the Journal of Clinical Psychiatry concluded.<\/strong><\/sup><\/p>\n<p align=\"justify\"><sup><strong>When, though, should the bereaved be medicated? For years, the official handbook of psychiatry, issued by the American Psychiatric Association, advised against diagnosing major depression when the distress is &ldquo;better accounted for by bereavement.&rdquo; Such grief, experts said, was better left to nature.<\/strong><\/sup><\/p>\n<p align=\"justify\"><sup><strong>But that may be changing.  In what some prominent critics have called a bonanza for the drug companies, the American Psychiatric Association this month voted to drop the old warning against diagnosing depression in the bereaved, opening the way for more of them to be diagnosed with major depression &mdash; and thus, treated with antidepressants&#8230;<\/strong><\/sup><\/p>\n<div align=\"justify\"><sup><strong>While no evidence has come to light showing that committee members broadened the diagnosis to aid the drug companies, the process of developing the handbook was fraught with financial links to the industry:<\/strong><\/sup><\/div>\n<ul><sup><strong>          <\/p>\n<li>\n<div align=\"justify\">Eight of 11 members of the APA committee that spearheaded the change reported financial connections to pharmaceutical companies &mdash; either receiving speaking fees, consultant pay, research grants or holding stock, according to the disclosures filed with the association. Six of the 11 panelists reported financial ties during the time that the committee met, and two more reported financial ties in the five years leading up to the committee assignment, according to APA records.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">A key adviser to the committee &mdash; he wrote the scientific justification for the change &mdash; was the lead author of the 2001 study on Wellbutrin, sponsored by GlaxoWellcome, showing that its antidepressant Wellbutrin could be used to treat bereavement&#8230;.<\/div>\n<\/li>\n<p>          <\/strong><\/sup><\/ul>\n<\/blockquote>\n<div>They are referring to this study:        <\/div>\n<blockquote>\n<div align=\"center\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11379835\" target=\"_blank\">Bupropion sustained release for bereavement: results of an open trial.<\/a><br \/>              <sup>by Zisook S, Shuchter SR, Pedrelli P, Sable J, and Deaciuc SC.<\/sup><br \/>              <strong><font color=\"#200020\">Journal of Clinical Psychiatry<\/font><\/strong>. 2001 62[4]:227-230.<\/div>\n<p>              <\/p>\n<div align=\"justify\"><sup><strong><u><font color=\"#200020\">OBJECTIVE<\/font><\/u>: The present study was conducted to assess whether DSM-IV-defined bereavement responds to bupropion sustained release [SR].<\/strong><\/sup><\/div>\n<div align=\"justify\"><sup><strong><u><font color=\"#200020\">METHOD<\/font><\/u>: Twenty-two  subjects who had lost their spouses within the previous 6 to 8 weeks  and who met DSM-IV symptomatic\/functional criteria for a major  depressive episode were evaluated. Subjects completed the Hamilton  Rating Scale for Depression [HAM-D], the Clinical Global Impressions  scale, the Texas Revised Inventory of Grief, and the Inventory of  Complicated Grief at baseline and follow-up. Subjects were treated with  bupropion SR, 150 to 300 mg\/day, for 8 weeks.<\/strong><\/sup><\/div>\n<div align=\"justify\"><sup><strong><u><font color=\"#200020\">RESULTS<\/font><\/u>: Improvement  was noted in both depression and grief intensity. For the  intent-to-treat group. 59% experienced a reduction of <u>&gt;<\/u> 50% on  HAM-D scores. The correlations between changes in the HAM-D scores and  the grief scale scores were high, ranging from 0.61 [p = .006] to 0.44  [p = .054].<\/strong><\/sup><\/div>\n<div align=\"justify\"><sup><strong><u><font color=\"#200020\">CONCLUSION<\/font><\/u>: Major depressive symptoms  occurring shortly after the loss of a loved one [i.e., bereavement]  appear to respond to bupropion SR. Treatment of these symptoms does not  intensify grief; rather, improvement in depression is associated with  decreases in grief intensity. The results of this study challenge  prevailing clinical wisdom that DSM-IV-defined bereavement should not be  treated. Larger, placebo-controlled studies are indicated.<\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">Their point in the article is about the ubiquitous conflicts of interest among the DSM-5 Task Force membership, and particularly in this case of a person prominent in the group recommending that the Bereavement exclusion be dropped who did an industry funded trial of a drug to treat grief. Point taken. My point is that the study itself was uncontrolled! Considering the often dramatic placebo effect in clinical trials, who has any idea what a 59% <u>&gt;<\/u> 50% fall in HAM-D scores means?<\/div>\n<p align=\"justify\">And for that matter, is grieving with a lower HAM-D score better? My own perspective on this particular issue has to do with what they think Major Depressive Disorder really represents. Is it a Disorder, a Disease, or is it just feeling real bad? Because they seem to see it as separable from grief only by duration or magnitude. And what does grief represent? Is it simply an unwanted feeling? About the only conclusion that makes any sense is that they see it as yet another opportunity to use antidepressants. I&#8217;ve never personally heard anyone say that there was a &quot;<em>prevailing clinical wisdom that DSM-IV-defined bereavement should not be  treated.<\/em>&quot; It feels more like a straw man to get people to prescribe antidepressants to grieving people.       <\/p>\n<p align=\"justify\">There are a couple of tables attached to the article that are of interest [<a target=\"_blank\" href=\"http:\/\/www.washingtonpost.com\/business\/economy\/defining-depression\/2012\/12\/26\/bbbf6b24-4fc6-11e2-950a-7863a013264b_graphic.html\">here<\/a>] showing the extent of some of these conflicts of interest. Note particularly the ones for Madhukar Trivedi who is on the APA Depression Guidelines panel [affiliated with 18 pharmaceutical manufacturers].&nbsp;        <\/p>\n<div align=\"justify\">I found the whole article embarrassing on a number of counts like the extensive industry connections and the lame rationalizations that it didn&#8217;t matter. But the main embarrassment was at how trivial the whole thing seems. I don&#8217;t personally think that the question of whether or not psychiatrists give Wellbutrin or not to grieving people is much of a leading edge topic in mental health these days. Which reminded me of another recent article where I thought the same thing:<\/div>\n<blockquote>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.washingtonian.com\/blogs\/wellbeing\/health\/6-things-to-know-about-the-revised-dsm-5.php\">6 Things to Know About the Revised DSM-5<\/a><br \/>      <strong><font color=\"#200020\">The Washingtonian<\/font><\/strong><br \/>      By Melissa Romero<br \/>      December  3, 2012<\/div>\n<p>      <\/p>\n<div align=\"justify\"><sup><strong>On Saturday, revisions to the Diagnostic and Statistical  Manual of Mental Disorders (DSM) were approved by the Arlington-based  American Psychiatric Association&rsquo;s board of trustees, including the  elimination of the term &ldquo;Asperger&rsquo;s disorder&rdquo; and &ldquo;mental retardation.&rdquo; The DSM had its last major revision almost two decades  ago, in 1994. With the wealth of new scientific evidence on various  mental illnesses and epidemiology, it was due time and necessary for the  American Psychiatric Association to revise its current diagnostic  system, APA president Dr. Dilip Jeste wrote in a statement. We spoke with APA chair Dr. David Kupfer, one of  the major leaders of the task force group, to get more information about  the DSM-5 revisions and what they mean for clinicians and patients.<\/strong><\/sup><\/div>\n<ol><sup><strong>         <\/p>\n<li>\n<div align=\"justify\">The term &ldquo;Asperger&rsquo;s disorder&rdquo; is being dropped. A  main concern among parents with children diagnosed with Asperger&rsquo;s  disorder was the proposal to drop the term from the manual. While it has  been eliminated, it will be incorporated under the new umbrella term  &ldquo;autism spectrum disorder,&rdquo; says Kupfer. &ldquo;We decided to place autistic  disorder, Asperger&rsquo;s, childhood integrative disorder, and pervasive  mental development disorders under one umbrella of diagnoses to allow  clinicians to make more precise set of decisions and assessments about  the children.&rdquo;<\/div>\n<\/li>\n<li>\n<div align=\"justify\">&ldquo;Mental retardation&rdquo; is being changed to &ldquo;intellectual developmental disorder.&rdquo; It&rsquo;s  no longer politically correct to say one suffers from &ldquo;mental  retardation.&rdquo; The new term, intellectual developmental disorder, has  long been used by the World Health Organization&#8217;s International  Classification of Disorders. &ldquo;We felt it was important to be aligned  with what&rsquo;s going on with the rest of the world,&rdquo; says Kupfer. &ldquo;We  wanted to have this manual as harmonized with them as possible.&rdquo;<\/div>\n<\/li>\n<li>\n<div align=\"justify\">There&rsquo;s a bigger focus on post-traumatic stress disorder (PTSD). &ldquo;We  paid much more attention to post-traumatic stress disorder with what&rsquo;s  been going on with the armed forces,&rdquo; says Kupfer. That includes  information on diagnoses and treatment for PTSD from sports injuries, as  well.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Eating disorders are more defined. &ldquo;Eating  disorders affect people across the whole lifespan,&rdquo; says Kupfer. But the  task force group felt that there were children and adolescents being  diagnosed with eating disorders not otherwise specified 50 percent of  the time, he adds. New guidelines include more precise diagnoses  criteria. Binge-eating disorder has become a main category section, for  example.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">The manual will be approximately 800 to 1,000 pages. The  DSM-5 may be hefty, but for the first time next year, an electronic  version will be available, including videos of assessments on patients,  references, and more. &ldquo;It&rsquo;s very important to make sure patients and  families really understand what&rsquo;s going on,&rdquo; says Kupfer. &ldquo;So in many  ways we&rsquo;re trying to put things together that make it more  user-friendly.&rdquo;<\/div>\n<\/li>\n<li>\n<div align=\"justify\">It may be a couple more decades until the next major revision. While  it will likely be some time before we can expect a DSM-6, it may only  be a few years until a DSM-5.1 or -5.2, thanks to the expected digital  version of the manual. &ldquo;We don&rsquo;t wait to wait another 19 to 20 years to  have a new revision of the whole volume,&rdquo; says Kupfer. &ldquo;But if there is  some unexpected consequence, which we can&rsquo;t anticipate, we have an  opportunity to fix something two to three years from now.&rdquo;<\/div>\n<\/li>\n<p>     <\/strong><\/sup><\/ol>\n<\/blockquote>\n<div align=\"justify\">I&#8217;ve been so focused on the quirky things they were trying to add and the botched Field Trials that I failed to notice how inconsequential the changes they did make actually were. A few name changes and changes in emphasis. Let&#8217;s face it, there&#8217;s not really very much there. After such a lofty lead-in, there&#8217;s little to show for the last twenty years. That&#8217;s kind of embarrassing too&#8230;   <\/div>\n<hr size=\"1\" \/>\n<div><strong><font color=\"#004400\">Pharmalot<\/font><\/strong>&#8216;s take on the WaPo article: <a target=\"_blank\" href=\"http:\/\/www.pharmalot.com\/2012\/12\/bereavement-depression-happy-drugmakers-pt-2\/\">Bereavement, Depression &amp; Happy Drugmakers<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>The recent article in the Washington Post deserves reading, but you probably know everything it has to say. Here&#8217;s a simple point: Antidepressants to treat grief? Psychiatry panelists with ties to drug industry say yes Washington Post with Bloomberg By Peter Whoriskey December 26, 2012 It was a simple experiment in healing the bereaved: Twenty-two [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-31408","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/31408","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=31408"}],"version-history":[{"count":11,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/31408\/revisions"}],"predecessor-version":[{"id":31420,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/31408\/revisions\/31420"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=31408"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=31408"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=31408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}