Markham's Behavioral Health

Antidepressants or psychotherapy for depression? Psychotherapy works better.

OK, now I'm ticked. Last week there was all this ballyhoo about how antidepressants help with depression according to a study done by NIH.

Well, even though the pharmaceutical companies are overjoyed, the fact is that psychotherapy works just as well as antidepressants. Of course, psychotherapists don't have billions of dollars to spend in advertising their services on the evening news.

If you doubt me, I will provide the evidence over the next few weeks.

The first article I have reviewed was published in the August, 2002 issue of none other than the American Journal of Psychiatry.

"Remission in Major Depressive Disorder: A Comparison of Pharmacotherapy, Psychotherapy, and Control Conditions", Nicola Casacalenda, M.D., J. Christopher Perry, M.P.H., M.D. and Karl Looper, M.D.

Here's the study's conclusions:

The percentages of remission for all patients randomly assigned to medication, psychotherapy, and control conditions were 46.4%, 46.3%, and 24.4%, respectively. Furthermore, significantly more patients dropped out of control conditions (54.4%) than either treatment with medication (37.1%) or psychotherapy (22.2%). CONCLUSIONS: Both antidepressant medication and psychotherapy may be considered first-line treatments for mildly to moderately depressed outpatients.

Notice that fewer patients dropped out of the psychotherapy group than the control group or the medication group.

There are other studies which show that the long term gains from psychotherapy are much better than for medications alone and there is less relapse.

Link: Remission in Major Depressive Disorder: A Comparison of Pharmacotherapy, Psychotherapy, and Control Conditions -- Casacalenda et al. 159 (8): 1354 -- American Journal of Psychiatry.

Natural Recovery and Treatment-Seeking in Pathological Gambling

There is an interesting study in the February, 2006 issue of the American Journal Of Psychiatry by Dr. Wendy Slutske which studied people who had been identified in two national surveys as compulsive gamblers.

Following up on people who had enough symptoms of compulsive gambling to be diagnosed, Dr. Slutske found that 36 - 39% gave up gambling and had no symptoms for over a year all on their own. These people are said to have "naturally recovered" without any professional treatment or self help support such as Gamblers Anonymous.

The conclusions drawn are that perhaps compulsive gambling is not the persistant, chronic disorder it once was thought to be. However, it seems also to be the fact that 2/3rds of the people identified as having compulsive gambling problems continued to have them.

In another article, in this same issue of the AFP journal, there was a finding that the medication, nalmefene, brand name is Revex, might be helpful in dealing with the "addiction" to gambling not the activity itself.

In an editorial at the beginning of the journal, it is pointed out that the focus of treatment should be on the addiction which causes biochemical changes in the brain not on the activity per se. It appears from the Slutske study that about 1/3 of people for whom gambling becomes a problem can change the behavior on their own without any treatment. The argument could be made that these people don't become "addicted" in the true sense of the word, but merely indulge in what has become a harmful habit. Other people, however, may actually have changes in their brain chemistry which leads to a compulsivity that could benefit from pharmacological and psychotherapeutic treatment.

Link: Natural Recovery and Treatment-Seeking in Pathological Gambling: Results of Two U.S. National Surveys -- Slutske 163 (2): 297 -- American Journal of Psychiatry.

Do you care that your government is spying on you?

This week's show on A World Of Possibilities is entitled "Tapped: Domestic Surveillance In The Age Of Terror". Do Americans care that they have given up one of their most basic rights, the right to privacy?

In the age of snail mail and hard wired telephones, it was very difficult for the government to physically put a tap on your phone or to get a warrant to open your mail, but in the age of electronic communication it is simple. Does knowing that people might be listening in on your cel phone or reading your email communications dampen the tendency for free expression of ideas especially if they are unpopular?

Of course it does.

We are increasingly living in the age of fear and anxiety. The government has us believing that there is a sexual predator, a rapist, a terrorist around every corner, and lurking in every conceivable space. If we are afraid enough, then we will become a nation of sheep and do what they tell us in return for their promise to keep us safe.

Having worked over 35 years in the mental health field, I am very experienced in working with people who have paranoid delusions, auditory hallucinations, and disorganized thinking. One of the most common themes that delusions and hallucinatory experience involve after religious delusions, are persecutorial delusions that the government is bugging, tracking, and gathering information on them, and other people for nefarious reasons.

With the current national climate of NSA spying, it is becoming increasingly difficult to tell the sane from the insane. And just because you might be paranoid doesn't mean that the government doesn't have you under surveillance.

Are Americans willing to give up their civil liberties and their freedom to idiots who promise to keep them safe. Are they really that stupid to fall for such disengenuous scare tactics?

If you think that your government has the competence and good sense to keep you safe look at the mess in Iraq, and look at the mess in New Orleans, and look at the mess of the Medicare Part D prescription drug program.

This Republican Administration claimed to be the children of Ronald Reagan who said that the nine most disengenuous words ever spoken are "I'm from the government and I'm here to help you." Reagan and his brand of conservatives seemed to believe that the less government the better. Bush and his neo-cons seem to believe not only in unlimited spending and huge government, but government with expanded powers. It is ironic that the supposed new reason that Bush says we are fighting in Iraq is not because of WMD, etc., but to spread democracy and freedom around the world whether people want it or not, and whether the community of nations think it is a good idea or not. Iraq is certainly not better off today, and Americans, who perpetrated this immoral pre-emptive war, are not more free.

It is hard for me as a psychotherapist to understand how people will feel more free when they are surreptitiously under the surveillance of their government. I can understand how they might feel more safe, but I don't understand how they could feel more free. Iam reminded of the motto on the New Hampshire license plates, "Live free or die." I think the motto referred to external threats not to the loss of freedom to one's own government.

To listen to the show, click on the link below.

Link: "A World of Possibilities" This Week's Program.

Marital Rape: New Research and Directions

How common is marital rape?

It appears that the prevalence of marital rape is about 10 - 14% of married women. About 1/3 of women state that they have had "unwanted" sex with their spouses. Raquel Kennedy Bergen has written an interesting article entitled, "Marital Rape: New Research and Directionts" which is posted on the Violence Against Women web site. Here is a brief statement from the summary of her article.

Approximately 10-14% of married women are raped by their husbands in the United States. Approximately one third of women report having "unwanted sex" with their partner. Historically, most rape statutes read that rape was forced sexual intercourse with a woman not your wife, thus granting husbands a license to rape. On July 5, 1993, marital rape became a crime in all 50 states, under at least one section of the sexual offense codes. In 20 states, the District of Columbia, and on federal lands there are no exemptions from rape prosecution granted to husbands. However, in 30 states, there are still some exemptions given to husbands from rape prosecution. In most of these 30 states, a husband is exempt when he does not have to use force because his wife is most vulnerable (e.g., she is mentally or physically impaired, unconscious, asleep, etc.) and is unable to consent.

If you would like to read Ms. Bergen's article click on the link below.

Link: VAWnet :: Marital Rape: New Research and Directions - Document Summary.

Rape victimization: characteristics and dynamics

The idea that "rape" is woman being mugged by an attacker from behind the bushes or in a dark alley is a cultural myth not that it doesn't rarely occur because it does, but this is the exceptional scenario for rape. Most rapes happen to people under 18, and are perpetrated by someone who is known to the victim. Further, the liklihood that a female is raped as an adult is twice as likely if she had already been raped as a minor.

If you are interested in the facts about rape and not the myths, you migh want to read a report which The National Intitute on Justice issued in January, of 2006 on rape entitled "Extent, Nature, and Consequences of Rape Victimization: Findings From The National Violence Against Women Survey". Approximately 300,000 women and 93,000 men are raped every year in the United States almost half of which were raped prior to age 18.

Almost 18 million women and almost 3 million men in the United States have been raped. One of every six women has been raped at some time. In a single year, more than 300,000 women and almost 93,000 men are estimated to have been raped. Rape prevalence rates were the same for minority and nonminority women, but differences were found by specific racial and ethnic group. Younger women were significantly more likely to report being raped at some time in their lives than older women. More than half of the female victims and nearly three-quarters of the male victims were raped before their 18th birthday. Women who reported being raped as minors were twice as likely to report being raped as adults.

Often times, especially for females, the rapist is known to the victim, and the vast majority of rapes are never reported to the police.

Female victims are significantly more likely than male victims to be raped by a current or former intimate partner and to sustain an injury during a rape. Many rape victims suffer serious mental health consequences. Only one in five adult women report their rape to the police. About half of the women raped as adults who had contact with police and about half who had contact with the courts were satisfied with their treatment.

To read the report on line or download a PDF file of the report click on the link below

Link: National Institute of Justice - Publications and Products.

Quote of the day

"To ignore that - not to know that the history of our country is a history of slaveholder against salve, landlord against tenant, corporation against worker, rich against poor - is to render us helpless before all the lesser lies told to us by people in power."

Howard Zinn

Best Of The Left radio

Best Of The Left is some of the best radio I have heard in a long time.

Each show is clips of left leaning radio shows such as Mother Jones Radio, Thom Hartman, the Majority Report, the Young Turks, Al Franken, Ring of Fire, etc. The clips are usually organized around a daily theme. Often times the clips include interviews with experts and various political figures. The clips also showcase some of the best analysis I have heard on current events and contemporary topics.

You can download the shows or listen to them on line.

The show on March 27, 2006, "Straight from the horse's ass, I mean mouth", has clips of Bush and Rumsfeld caught in outright lies to the American people. It is pretty funny if it wasn't so sad what bungling idiots are running this country. I found it particularly insightful when Rachel Maddow says in a throw away line that George W. Bush acts like a cocky 14 year old. This is a very insightful comment especially when one considers that emotional and social development is often arrested when people start abusing chemcials. It is a well known fact that President Bush was an active alcohol abuser and drug abuser until he was 40. Those years of substance abuse have taken then toll on his emotional, social, and cognitive functioning.

I highly recommend Best Of The Left. To check it out click on the link below.

Link: For MP3 Format.

Quote of the day

"In the history of secrets, withheld from the American people, this the biggest secret: that there are classes with different interests in this country."

Howard Zinn

Censorship and self censorship of the American media

On 02/21/06, A World Of Possibilities first broadcast its show on media censorship entitled, "Smoldering Thoughts, Swallowing Tongues: Censorship and Self Censorship In The American Media".

On the World Of Possibilities web site they descibe the show as follows:

Political and commercial pressures have paled a once proud free press. Censorship smothers reporters' thoughts before words are penned or spoken. Join us as we hear not from the radical fringes of the media reform movement but from celebrated mainstream journalists asking how long our fragile democracy can withstand the absence of accurate information and open inquiry.

While politicians have always threatened to cut off or limit access to information to journalists who do not "play ball" with their policies, it seems that as media outlets have consolidated into huge corporations and they have become more commercialized with attention to profits, journalists and the media have become less independent and less likely to report the truth which might create controversy or portray those in power in a bad light.

Some of this censorship is scary such as NASA climate scientist James Hanson having his scientific reports on climate change edited by a 24 year old political PR hack to bring the scientific facts more in line with the administration's energy policies. It is further a travesty in a democracy to find that Americans and the congress were lied to about the reasons and need to engage in a pre-emptive war of aggression against Iraq, a war which the Pope and most of our European allies saw as immoral and uncalled for.

A democracy of free people depend on the truth to make good decisions and choices and yet when the disinformation being purveyed by a syncophantic media is being used by the voting public to make political decisions, the nation is in peril.

If it is true that the pen is mightier than the sword, and that the true path to freedom and democracy is winning the hearts and minds of citizens, our contemporary media which has become a form of entertainment rather than an instrument of education and elucidation, has let us down as a nation and is not worthy of our respect.

If you are interested in this issue of the role of the media in a free and democratic society, you will enjoy this show and find it informative,

Click on the link below to go to the A World Of Possibilities web site and you can listen to the show on line,

Link: "A World of Possibilities" Program Details.

Phone counseling helps smokers quit

Reuters reported on March 16, 2006 on a study which appears in the March, 2006 issue of the Archives of Internal Medicine which found that smokers who received telephone counseling were more successful in their quit attempt than smokers who did not receive such assistance.

A year after the program began, 13 percent of the participants in the telephone counseling program had quit smoking for at least six months, compared to 4 percent of those receiving standard care.

Of course, to those of us in the substance abuse field, this makes perfect sense. Nobody would expect a heroin addict to quit shooting heroin just because their doctor told them to quit at a regular doctor's visit and handed them a pamphlet. And yet some professionals compare nicotine addiction to heroin addiction in its tenaciousness if not its physical withdrawal.

"Nobody expects a doctor to cure a patient with diabetes and hypertension in one visit," An said. "That tends to be the way the health care system has dealt with smoking, and we're really trying to change that."

An and his team evaluated a telephone care program, in which 417 smokers spoke by telephone to trained counselors at least seven times over two months. The counselors helped the smokers develop a quitting plan, arranged for them to get prescriptions for anti-smoking medications and receive them through the mail, offered counseling and helped them find additional counseling help.

Another 420 smokers received standard care, meaning they got self-help publications on quitting smoking through the mail and their physicians may have spoken to them about quitting. They also had access to smoking cessation programs through the VA.

Three months after the beginning of the study, 39 percent of the telephone care participants reported having abstained from cigarettes for at least the past seven days, compared to 10 percent of the control group.

Many people change their habits and addictions without any help, and yet for those having difficulty making those changes, external support and coaching can make a huge difference in making those changes possible.

Link: MedlinePlus: Phone counseling helps smokers quit.