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Patient treatment preferences in an RCT (in this case antidepressants vs counselling for depression)

Discussion in 'Other Health News and Research' started by Dolphin, Jun 28, 2013.

  1. Dolphin

    Dolphin Senior Member

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    Patient preferences haven't got much attention in the ME/CFS area. Many patients don't want to undertake graded activity/exercise programmes, for example. So I thought this paper that James C. Coyne just highlighted on Twitter, was of interest.

    It's from 2005, but the point is just as interesting today.


     
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  2. Esther12

    Esther12 Senior Member

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    Ta D.

    This made me think of another recent paper, this one being used to justify explanations of illness which downplay the role of bioloigcal mechanisms in an 'empowering' way. Although obviously, decisions about whether to do this cannot be done with informed consent:

    http://www.sciencedirect.com/science/article/pii/S0272735813000883

    To me, it seems like there's a real conflict in psychology/psychiatry between those who think that their remarkable expertise is such that they should decide how their patients should think and live their lives, and those who realise that our poor understanding of many psychological matters only lets them make quite limited claims to patients, and that much needs to be left to the preferences of patients. It really seems like two totally different approaches, that will not be able to find a compromise, but need to have one side win over the other.
     
  3. SOC

    SOC Senior Member

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    Confession up front: I'm grouchy today.

    I think this research is just stupid. The unstated assumption, as far as I can tell, is that talk therapy and antidepressant meds are interchangeable. It's like assuming antibiotics and pain meds are interchangeable because both make you feel better when you have a bug. "Nah, I don't want to take antibiotics. Give me pain meds instead so I won't notice that I'm sick."

    If ya ask me, it's just another case of talk therapists trying to find another niche for themselves. "If your patient doesn't want to take the meds they need, send them to me and maybe I can convince them they're only imagining their physiological problem. At least I'll make some money and they might quit complaining."

    Talk therapy and anti-depressant medication treat different things and most up-to-date psychiatrists know this. Some people develop self-destructive or counter-productive thinking processes. They need talk therapy to help them learn that they are not responsible for everything or they're not a terrible person because their cheating wife left them for another man or that they don't have to be perfect or yadda, yadda, yadda. Antidepressant meds can make them more numb, but is it wise to mess with the neurochemistry of normally functioning brains?

    Other people have neurochemical disorders that affect emotions. You can talk all you want, it's not going to change the neurochemistry (significantly, at least). Those people need meds to correct a physiological disorder. Some people have both problems as one can lead to another. Those people need talk therapy and meds. That does not make the two interchangeable.

    It's just another area where some psychologists think their brand of "magic" can cure physiological phenomena by thinking it away. Talk therapy to fix maladaptive thinking -- fine. Talk therapy to learn coping skills for difficult situations -- fine. Talk therapy to fix physiological dysfuntions -- snake oil. I don't buy faith healing in religion either, by the way.

    [grumble, grumble, grumble]
     
  4. Esther12

    Esther12 Senior Member

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    In some ways, I see the paper Dolphin posted as something of a challenge to that assumption, in that it could reflect that patients themselves can have an awareness of the nature of their problems that allows them to choose the more effective treatment for themselves.
     
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  5. biophile

    biophile Places I'd rather be.

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    Couldn't this paper also be used to claim that those who aren't "receptive" to anti-depressants are sabotaging potential benefits from them and should be "educated"? ME/CFS patients who aren't "receptive" to CBT/GET face similar attitudes.

    Re the other paper, here is a shocking idea for when etiology is unknown: offer the patient a wide range of accurate information in the spirit of openness and let them decide for themselves what the cause of their symptoms is?
     
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  6. SOC

    SOC Senior Member

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    What!? Give the patients all the info and give them choices!? Surely not! ;)
     
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  7. Esther12

    Esther12 Senior Member

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    Or even not decide for themselves, but instead just live honestly with the uncertainty rather than pragmatically formulating narratives of yadda-yadda.

    I really wish that when I was first ill I had just been provided with access to the available evidence, and left to sort it out for myself. The psychosocial management that is routinely inflicted upon CFS patients is just not morally justifiable given how tenuous the evidence in this area is.
     

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