Subject(s)
Behavior Therapy , Counseling , Smoking Cessation/methods , Smoking Prevention , Humans , Self-Help GroupsABSTRACT
Antidepressant medication has apparently become the most popular treatment for depression in the USA. Several beliefs about the efficacy of antidepressant medications prevail among mental health professionals and the public. This paper explores relevant research data and raises questions about these beliefs. Many of the common beliefs about these medications are not adequately supported by scientific data. The following issues are raised: (1) industry-funded research studies which result in negative findings sometimes do not get published; (2) placebo washout procedures may bias results in some studies; (3) there are serious questions about the integrity of the double-blind procedure; (4) the 'true' antidepressant drug effect in adults appears to be relatively small; (5) there is minimal evidence of antidepressant efficacy in children; (6) side effects are fairly common even with the newer antidepressants; (7) combining medications raises the risk for more serious complications; (8) all antidepressants can cause withdrawal symptoms; (9) genetic influences on unipolar depression appear to be weaker than environmental influences; (10) biochemical theories of depression are as yet unproven; (11) biological markers specific for depression have been elusive; (12) dosage and plasma levels of antidepressants have been minimally related to treatment outcome; (13) preliminary evidence suggests that patients who improve with cognitive-behavioral psychotherapy show similar biological changes as those who respond to medication, and (14) the evidence suggests that psychological interventions are at least as effective as pharmacotherapy in treating depression, even if severe, especially when patient-rated measures are used and long-term follow-up is considered.
Subject(s)
Antidepressive Agents/therapeutic use , Depressive Disorder/drug therapy , Drug Evaluation/methods , Health Knowledge, Attitudes, Practice , Adult , Antidepressive Agents/adverse effects , Bias , Child , Conflict of Interest , Contraindications , Drug Evaluation/economics , Drug Evaluation/trends , Drug Therapy, Combination , Economics, Pharmaceutical/trends , Female , Humans , Male , Meta-Analysis as Topic , Publishing/economics , Publishing/standards , Reproducibility of Results , Research DesignABSTRACT
Anxiety is the most common mental health problem in the United States. Most patients with anxiety seek treatment from primary care physicians, who are generally familiar with the pharmacologic management of anxiety. However, many problems are associated with the use of antianxiety medications, and increasing evidence shows that certain nondrug strategies are effective, particularly in patients with mild to moderate symptoms. The key features of nondrug treatment can be summarized under the mnemonic "A-E-I-O-U." The physician assesses the nature and causes of the anxiety; educates the patient about the causes and management of anxiety; intervenes by teaching specific, effective anxiety-control techniques; observes and helps the patient monitor progress and, finally, helps the patient achieve understanding of anxiety and ways to prevent recurrence.
