• This is a political forum that is non-biased/non-partisan and treats every person's position on topics equally. This debate forum is not aligned to any political party. In today's politics, many ideas are split between and even within all the political parties. Often we find ourselves agreeing on one platform but some topics break our mold. We are here to discuss them in a civil political debate. If this is your first visit to our political forums, be sure to check out the RULES. Registering for debate politics is necessary before posting. Register today to participate - it's free!

Efficacy of psychotherapy overestimated for depression

US Conservative

US Conservative

Banned
DP Veteran
Joined
Nov 11, 2013
Messages
33,522
Reaction score
10,826
Location
Between Athens and Jerusalem
Gender
Male
Political Leaning
Conservative
HealthDay News — The benefits of psychological therapy for depression are overstated, according to research published online in PLOS ONE.

The researchers analyzed 55 studies funded by the U.S. National Institutes of Health between 1972 and 2008 and concluded that psychological therapy is about 25 percent less effective than previously thought, The New York Times reported. Specifically, psychological therapy for depression is effective for about 20 percent of patients, rather than the previous figure of nearly 30 percent.

http://www.clinicaladvisor.com/web-...1&spJobID=640546537&spReportId=NjQwNTQ2NTM3S0

Interesting findings, I think psychologists, psych techs, etc have been overstating the benefits, by omitting any unflattering studies.

On a separate note, exercise has been found to be at least as effective as medications.
 
Psycologists mostly just drug their patients and seldom deal with the underlying causes of depression.


Good to know exercise is just as effective.
 
Moot said:
Psycologists mostly just drug their patients and seldom deal with the underlying causes of depression.


Good to know exercise is just as effective.
Click to expand...

Actually, Psychologists dont drug anyone at all, but it appears they are still fairly ineffective.
 
US Conservative said:
Actually, Psychologists dont drug anyone at all, but it appears they are still fairly ineffective.
Click to expand...

I get them confused so I had to look it up and you're right...it's psychiatrists that can prescribe drugs but psychologists and psychoanalysts can't.
 
Is there an anti-depressant with a better rate of successful treatment?
 
spud_meister said:
Is there an anti-depressant with a better rate of successful treatment?
Click to expand...

There are, especially if this meta analysis is true, though most studies dont compare individual drugs (but sometimes classes of drugs) to therapy. Its important to find the right drug and dose, and every patient is different.

Still, therapy may be effective for some especially when combined with meds because treatment is generally more effective when a disease is attacked from more than one side.
 
Paleocon said:
And is less likely to kill you.
Click to expand...

Its very hard to determine what is and isn't a factor with psych meds in particular.

You are giving meds to the same population that has a much higher risk of self harm.

Exercise is beneficial for other reasons as well, but it too has risks.
 
US Conservative said:
HealthDay News — The benefits of psychological therapy for depression are overstated, according to research published online in PLOS ONE.

The researchers analyzed 55 studies funded by the U.S. National Institutes of Health between 1972 and 2008 and concluded that psychological therapy is about 25 percent less effective than previously thought, The New York Times reported. Specifically, psychological therapy for depression is effective for about 20 percent of patients, rather than the previous figure of nearly 30 percent.

http://www.clinicaladvisor.com/web-...1&spJobID=640546537&spReportId=NjQwNTQ2NTM3S0

Interesting findings, I think psychologists, psych techs, etc have been overstating the benefits, by omitting any unflattering studies.

On a separate note, exercise has been found to be at least as effective as medications.
Click to expand...

Actually that's not really quite right because the study was a metaanalysis which is powerful because you have to show a dramatic effect for a meta analysis to show efficacy.

The take away is more likely that psychological therapy is either not effective on all types of depression.. or that only certain types of psychological therapy is more effective.
 
jaeger19 said:
Actually that's not really quite right because the study was a metaanalysis which is powerful because you have to show a dramatic effect for a meta analysis to show efficacy.

The take away is more likely that psychological therapy is either not effective on all types of depression.. or that only certain types of psychological therapy is more effective.
Click to expand...

Why does a meta analysis have to show a dramatic effect to be efficacious? Its just a study of other studies.

I haven't read the study (just the abstract)-but you should feel free to do so-than you can see what types of depression were studied.
 
US Conservative said:
Why does a meta analysis have to show a dramatic effect to be efficacious? Its just a study of other studies.

I haven't read the study (just the abstract)-but you should feel free to do so-than you can see what types of depression were studied.
Click to expand...

Very large N.
 
US Conservative said:
Why does a meta analysis have to show a dramatic effect to be efficacious? Its just a study of other studies.

I haven't read the study (just the abstract)-but you should feel free to do so-than you can see what types of depression were studied.
Click to expand...

The power of the meta analysis is that it combines multiple studies together and gives you a much bigger N and usually over a number of studies.

We would have to look at each study to see. But the likelihood is that not each study is exactly identical in methodology.
So lets take a hypothetical (because it won't be in the abstract)

Lets say of 55 studies. 10 of those studies were on newly diagnosed situational depression in teenagers. Treatment ranged from three times a week to once a month. And efficacy ranged from 40% to 60% depending on intensity and type of psychological therapy.

Lets say that another 10 of those studies were on newly diagnosed situational depression in adults.. treatment ranged from twice a week to once a week.. and efficacy ranged from 40 to 50%. depending on intensity and type of therapy.

Lets say that 15 of those studies were on long term clinical depression in geriatric adults and treatment ranged from once a week to once every three months and efficacy ranged from 10% to 20% over controls.

Then another 10 studies were on long term clinical depression of adults 20-45 and treatment ranged from once a week to once a month and they had an efficacy rate that ranged from 20% to 40% over controls.

And another 10 studies of clinical depression of less than 4 years of adults had an efficacy of 30%.

Now depending on the number of studies.. and the N in each study.. each group will bring a certain power. SO... even though in say young adults.. and doing psychotherapy in newly diagnosed patients is highly effective... because psychotherapy for geriatric patients is not as effective by far... the overall efficacy could end up quite low.

Based on that evidence.. you don't conclude that psychotherapy is not effective. You conclude its not effective for everyone and therefore routinely ordering psychotherapy regardless of approach, or intensity or patient factors is not indicated. However, its very possible that psychotherapy for certain individuals at certain intensities can be quite effective.

That's why you have to have a dramatic effect for a meta-analysis to show efficacy.

That's its power. NOW.. lets say you do a meta analysis on psychotherapy and find that it shows an efficacy of 50% over all those studies... THEN you can conclude that if a person walks through your door with depression.. they darn well should leave with a prescription for psychotherapy.

The problems is that layman in the insurance companies often don't understand what a meta analysis is.. and have taken proven treatments that are proven and well established in the literature for specific types of cases.. and taken them off the "allowed procedures list".. because a meta analysis that covered studies with varying populations and intensities etc had a low efficacy rate overall.
 
Moot said:
I get them confused so I had to look it up and you're right...it's psychiatrists that can prescribe drugs but psychologists and psychoanalysts can't.
Click to expand...

But, just to point out that your original post was still mostly wrong. psychiatrists do deal with the underlying causes of which said psychologists are involved - chemical imbalance.
 
The study and understanding of the mind is in it's infancy. Treating these disorders is hit and miss.

I would think therapy would help from the stand point of directing "correct thinking"...other than that...it's a crap shoot. Freud hasn't even been dead for a century yet.

I think that a holistic approach is the best way to go but that applies to everything in life.
 
jaeger19 said:
The power of the meta analysis is that it combines multiple studies together and gives you a much bigger N and usually over a number of studies.

We would have to look at each study to see. But the likelihood is that not each study is exactly identical in methodology.
So lets take a hypothetical (because it won't be in the abstract)

Lets say of 55 studies. 10 of those studies were on newly diagnosed situational depression in teenagers. Treatment ranged from three times a week to once a month. And efficacy ranged from 40% to 60% depending on intensity and type of psychological therapy.

Lets say that another 10 of those studies were on newly diagnosed situational depression in adults.. treatment ranged from twice a week to once a week.. and efficacy ranged from 40 to 50%. depending on intensity and type of therapy.

Lets say that 15 of those studies were on long term clinical depression in geriatric adults and treatment ranged from once a week to once every three months and efficacy ranged from 10% to 20% over controls.

Then another 10 studies were on long term clinical depression of adults 20-45 and treatment ranged from once a week to once a month and they had an efficacy rate that ranged from 20% to 40% over controls.

And another 10 studies of clinical depression of less than 4 years of adults had an efficacy of 30%.

Now depending on the number of studies.. and the N in each study.. each group will bring a certain power. SO... even though in say young adults.. and doing psychotherapy in newly diagnosed patients is highly effective... because psychotherapy for geriatric patients is not as effective by far... the overall efficacy could end up quite low.

Based on that evidence.. you don't conclude that psychotherapy is not effective. You conclude its not effective for everyone and therefore routinely ordering psychotherapy regardless of approach, or intensity or patient factors is not indicated. However, its very possible that psychotherapy for certain individuals at certain intensities can be quite effective.

That's why you have to have a dramatic effect for a meta-analysis to show efficacy.

That's its power. NOW.. lets say you do a meta analysis on psychotherapy and find that it shows an efficacy of 50% over all those studies... THEN you can conclude that if a person walks through your door with depression.. they darn well should leave with a prescription for psychotherapy.

The problems is that layman in the insurance companies often don't understand what a meta analysis is.. and have taken proven treatments that are proven and well established in the literature for specific types of cases.. and taken them off the "allowed procedures list".. because a meta analysis that covered studies with varying populations and intensities etc had a low efficacy rate overall.
Click to expand...

Insurance companies dont practice medicine. Why should a less effective treatment be considered by a practitioner?

Im not saying therapy wont work, and it does have benefits and drawbacks like all treatments.

The study clearly states it evaluated major depressive disorder-an unique condition. Being a meta-analysis, its highly likely that the studies being reviewed used different methodologies, but I dont see how that makes the study invalid.
 
US Conservative said:
Insurance companies dont practice medicine. Why should a less effective treatment be considered by a practitioner?

Im not saying therapy wont work, and it does have benefits and drawbacks like all treatments.

The study clearly states it evaluated major depressive disorder-an unique condition. Being a meta-analysis, its highly likely that the studies being reviewed used different methodologies, but I dont see how that makes the study invalid.
Click to expand...

I did not say the study was invalid.. hardly.. the study is a very powerful tool. Its in understanding what the tool means that's important.

Those major depressive disorder may be a unique condition.. but the people that effects.. and the types of psychotherapy treatment and the duration and intensity of treatment are likely all different and are captured in a meta analysis.

Insurance companies dont practice medicine. Why should a less effective treatment be considered by a practitioner?
Click to expand...

Insurance companies think they do though! "Pre authorization".. jeez. the last time I had to pre authorize a procedure.. which had been denied when we sent it in the normal channels.. I had to get on the line for the appeal. When the gal at the end was authorizing the procedure.. I asked how she wanted me to do the procedure.. what technique to use etc.. She stated "well sir you are the doctor.. I don't know the patient and aren't a doctor".. I said... "well then.. since you don't know how to treat this patient.. why are you making the decision of what treatment they can have"?

I have to deal with insurance companies that have no clue what a meta-analysis really is. So a patient that falls into the criteria for this procedure according to good research.. gets denied even though there is excellent support in the literature for this procedure with this particular patient group . Because this study shows it doesn't work (which means that it doesn't work for every type of patient).

But you ask a good question why should a less effective treatment be considered by a practitioner? I'll answer that and forgive the professorial tone, since I get asked this question by a lot of students.

1. Patient value: Patients may place a higher value on a less effective treatment than a more effective treatment for a variety of reasons. An example is a patient that might not want to undergo the most effective chemotherapy because the weakness or nausea that they feel with it interferes with spending time with their children.. or going on that elk hunt etc.

2. Compliance: Sometimes more effective treatment require more follow ups, or more care at home, lifestyle changes etc.. and the patient has neither the ability nor the will to be compliant with such. then a less effective procedure but requires less compliance may be indicated.

3. Finances: The more effective treatment may simply not be covered by insurance, or the cost even with insurance is more than the patient wishes to bear.. and therefore a less costly but also less effective treatment might be warranted.

4. Comorbidities: Patients may have other comorbidities that influence whether a more effective treatment is the right one over another. For example.. say a patient has a fracture and a joint replacement surgery would be more effective than a pinning for the bone. However, the patients comorbidities may make the longer but more effective surgery a greater risk for the patient .

5. Time: The practitioner may simply not have time to do a longer but more effective treatment. Particularly in fields or areas where practitioner time is at a premium. I have been in situations in third world countries where I was "IT".. and saw patients into the wee hours of the morning (pulled a 24 hour session) I did the most effective treatments for the time available.. otherwise they were not getting ANY care.
 
US Conservative said:
HealthDay News — The benefits of psychological therapy for depression are overstated, according to research published online in PLOS ONE.

The researchers analyzed 55 studies funded by the U.S. National Institutes of Health between 1972 and 2008 and concluded that psychological therapy is about 25 percent less effective than previously thought, The New York Times reported. Specifically, psychological therapy for depression is effective for about 20 percent of patients, rather than the previous figure of nearly 30 percent.

http://www.clinicaladvisor.com/web-...1&spJobID=640546537&spReportId=NjQwNTQ2NTM3S0

Interesting findings, I think psychologists, psych techs, etc have been overstating the benefits, by omitting any unflattering studies.

On a separate note, exercise has been found to be at least as effective as medications.
Click to expand...

pretty discouraging. depression is a tough condition to deal with. hopefully one day a more effective treatment will be developed but until then at least we know that current methods aren't working (according to this study which i haven't read, at least).
 
jaeger19 said:
I did not say the study was invalid.. hardly.. the study is a very powerful tool. Its in understanding what the tool means that's important.

Those major depressive disorder may be a unique condition.. but the people that effects.. and the types of psychotherapy treatment and the duration and intensity of treatment are likely all different and are captured in a meta analysis.



Insurance companies think they do though! "Pre authorization".. jeez. the last time I had to pre authorize a procedure.. which had been denied when we sent it in the normal channels.. I had to get on the line for the appeal. When the gal at the end was authorizing the procedure.. I asked how she wanted me to do the procedure.. what technique to use etc.. She stated "well sir you are the doctor.. I don't know the patient and aren't a doctor".. I said... "well then.. since you don't know how to treat this patient.. why are you making the decision of what treatment they can have"?

I have to deal with insurance companies that have no clue what a meta-analysis really is. So a patient that falls into the criteria for this procedure according to good research.. gets denied even though there is excellent support in the literature for this procedure with this particular patient group . Because this study shows it doesn't work (which means that it doesn't work for every type of patient).

But you ask a good question why should a less effective treatment be considered by a practitioner? I'll answer that and forgive the professorial tone, since I get asked this question by a lot of students.

1. Patient value: Patients may place a higher value on a less effective treatment than a more effective treatment for a variety of reasons. An example is a patient that might not want to undergo the most effective chemotherapy because the weakness or nausea that they feel with it interferes with spending time with their children.. or going on that elk hunt etc.

2. Compliance: Sometimes more effective treatment require more follow ups, or more care at home, lifestyle changes etc.. and the patient has neither the ability nor the will to be compliant with such. then a less effective procedure but requires less compliance may be indicated.

3. Finances: The more effective treatment may simply not be covered by insurance, or the cost even with insurance is more than the patient wishes to bear.. and therefore a less costly but also less effective treatment might be warranted.

4. Comorbidities: Patients may have other comorbidities that influence whether a more effective treatment is the right one over another. For example.. say a patient has a fracture and a joint replacement surgery would be more effective than a pinning for the bone. However, the patients comorbidities may make the longer but more effective surgery a greater risk for the patient .

5. Time: The practitioner may simply not have time to do a longer but more effective treatment. Particularly in fields or areas where practitioner time is at a premium. I have been in situations in third world countries where I was "IT".. and saw patients into the wee hours of the morning (pulled a 24 hour session) I did the most effective treatments for the time available.. otherwise they were not getting ANY care.
Click to expand...

Totally get it, of course there are factors in treatments, that you have mentioned. My point wasn't that I wont recommend therapy to my patients, but that this might make me less likely to do so.
 
bg85 said:
pretty discouraging. depression is a tough condition to deal with. hopefully one day a more effective treatment will be developed but until then at least we know that current methods aren't working (according to this study which i haven't read, at least).
Click to expand...

Its devastating, and its so common that I hope we see more solutions in the future.
 
US Conservative said:
Totally get it, of course there are factors in treatments, that you have mentioned. My point wasn't that I wont recommend therapy to my patients, but that this might make me less likely to do so.
Click to expand...

I would suggest that you take apart the study to see which patient groups or methodology had the greatest effectiveness. Just a suggestion. that's the nice thing about a meta analysis as well.. they do all the searching for you. So you can pull the abstracts from the studies and find out which ones had the greatest effectiveness rather quickly.
 
You must log in or register to reply here.
Back
Top Bottom