Urban myths exposed

1242257784-vaillantPoints blog is back with a great interview with George Vaillant.

Here’s one of the questions and his response:

2. What do you think a bunch of alcohol and drug historians might find particularly interesting about your book?

The value of the Grant study to the history of alcoholism is the number of urban myths that it exposes, and for this reason it received the biennial Jellinek prize for the best research in alcoholism in the world.

The first urban myth exposed is that depression causes alcoholism. Our prospective study shows beyond a doubt that alcoholism causes depression.

Second, alcoholics have unhappy childhoods due to their parents’ alcoholism; unhappy childhoods without a history of alcoholism do not lead to alcoholism. Therefore, the relationship between childhood and alcoholism appears to be genetic.

The third urban myth exposed is that AA is only for a few alcoholics and drugs are more useful. There are no two-year or longer studies of Naltrexone, Antabuse, or Acamprosate that have been shown to be effective, nor has long-term follow-up of cognitive behavioral therapy proved to be effective. On the other hand, when we followed, over 60 years, our sample of roughly 150 alcoholics, the men who made complete recovery—that’s an average of 19 years of abstinence—as contrasted to those men who remained chronically alcoholic until they died, the men who “recovered” went to 30 times more AA meetings than the men who remained chronically ill. Like outgrowing adolescence, it takes a long time to learn to put up with AA, but when you do, it works.

Running over depression

Walking Feet

The Atlantic recently posted on the effectiveness of exercise to treat depression and the failure to integrate it into practice:

Percent of patients in each condition six months after treatment. (Psychosomatic Medicine)

Depression is the most common mental illness—affecting a staggering 25 percent of Americans—but a growing body of research suggests that one of its best cures is cheap and ubiquitous. In 1999, a randomized controlled trial showed that depressed adults who took part in aerobic exercise improved as much as those treated with Zoloft. A 2006 meta-analysis of 11 studies bolstered those findings and recommended that physicians counsel their depressed patients to try it. A 2011 study took this conclusion even further: It looked at 127 depressed people who hadn’t experienced relief from SSRIs, a common type of antidepressant, and found that exercise led 30 percent of them into remission—a result that was as good as, or better than, drugs alone.

Though we don’t know exactly how any antidepressant works, we think exercise combats depression by enhancing endorphins: natural chemicals that act like morphine and other painkillers. There’s also a theory that aerobic activity boosts norepinephrine, a neurotransmitter that plays a role in mood. And like antidepressants, exercisehelps the brain grow new neurons.

But this powerful, non-drug treatment hasn’t yet become a mainstream remedy. In a 2009 study, only 40 percent of patients reported being counseled to try exercise at their last physician visit.

Instead, Americans are awash in pills.

For Depression Treatment, Meditation Might Rival Medication – Forbes

Mindfulness-Doug Neill

A new study finds mindfulness meditation to be an effective treatment for depression:

On the list of ways in which meditation appears to benefit the brain, depression treatment may be the latest to gain scientific backing. A new review study, out yesterday in the Journal of the American Medical Association (JAMA) Internal Medicine, finds that mindfulness meditation may rival antidepressants in easing the symptoms of depression. The review is noteworthy for this reason: Its authors combed thousands of earlier studies on meditation, arriving at a small number of randomized clinical trials (the gold standard in science) for use in the analysis. Mindfulness meditation may not cure all, the research found, but when it comes to the treatment of depression, anxiety, and pain, the practice may be just as effective as medication.

How effective?

In the current study, the effect size for meditation on depression was found to be moderate, at 0.3.

. . .

But the results are more impressive when you keep in mind that the average effect size of antidepressant medication, the go-to method in the country, is also 0.3. So when it comes to treating depression, which has a notoriously low treatment success rate, the effect size for meditation in the current study is actually pretty impressive.

What’s the evidence for other problems?

There was no evidence for an effect of meditation on other measures, like attention, positive mood, substance use, eating habits, sleep and weight. Mantra meditation didn’t seem to carry the same effect as mindfulness meditation, but it may be in part because there were too few studies in the former to draw real conclusions.

via For Depression Treatment, Meditation Might Rival Medication – Forbes.

Depression, exercise, research and the media

A recent study on treating depression with exercise encouragement and advice has caused quite a stir. Check out the headlines.

But the paper itself says the following:

The main implication of our results is that advice and encouragement to increase physical activity is not an effective strategy for reducing symptoms of depression. Although our intervention increased physical activity, the increase may not have been sufficiently large to influence depression outcomes.

An article tackling the coverage of the study quotes the pay-walled editorial from the same issue of the medical journal:

Or, as the BMJ’s own editorial points out: “Patients in both groups therefore already received high quality care, and 57% were taking antidepressants at recruitment. It may have been difficult for the addition of a physical activity intervention to make an appreciable difference.” Further, about 25 per cent were already meeting Government exercise guidelines, so there may have been “little room for the intervention to make a difference”. The BMJ says that there has still been insufficient research.

I think that this is a very important point. It would be interesting to compare the following groups:

  1. exercise/no medication
  2. exercise/medication
  3. no exercise/medication
  4. no exercise/no medication

Further, look at the effect of exercise rather than the effect of advice and support. AND, follow them for at least a year. Then, if we establish exercise is helpful, we can look at whether it helps some but not others, what dose and frequency is needed, whether it’s helpful as an adjunct to other treatments, and THEN explore strategies for getting patients to exercise.

Another blog summarizes the study this way:

So, what did the study actually find? Two groups of depressed individuals were kept on their standard treatment plan and one of those groups was mildly encouraged to do more exercise through a few short telephone calls and a couple of face to face meetings. There was no minimum amount of exercise required for inclusion in the study, nor were any facilities for exercise provided. Over half of the participants were on anti-depressant medication that may provide some of the benefits of exercise alone, thus negating the benefit of exercise on self reported happiness.

At the four month follow up, exactly the same number of people in the treatment group had participated in physical activity as had done so in the control group (though it should be noted that there were seventeen more people in the control group than in the treatment group). Over the course of the study there was only a fifteen percent difference in the amount of exercise between the two groups! This study shows that the current exercise based treatment plan of telling people to exercise is not effective. It does not assess the outcomes of enabling people to exercise, or indeed of actually exercising.

“EXERCISE DOES NOT HELP DEPRESSION” is a good headline, but it’s not that simple and it’s not true.