What You Can Change _. And What You Can't - Martin E. Seligman [134]
4. Quantifying the effect of the antidepressants is not simple. Unlike the antipsychotics, there have been a large number of good outcome (double-blind, placebo-controlled) studies of the tricyclics. But depression goes away on its own in time, and so there is a high rate of remission with just a placebo, perhaps as high as 45 percent. A drug has to outperform the placebo to work, and this happens in only about two-thirds of outcome studies. Different studies quantify improvement in many different ways, and this also makes comparison difficult. A consensus figure is that about 65 percent of patients improve noticeably with the tricyclics. See, for example, the useful review by Phillip Berger, “Antidepressant Medications and the Treatment of Depression,” in J. Barchas, P. Berger, R. Ciaranello, and G. Elliot, eds., Psychopharmacology (New York: Oxford University Press, 1977), 174–207. For a good recent study, see K. White, W. Wykoff, L. Tynes, L. Schneider, et al., “Fluvoxamine in the Treatment of Tricyclic-Resistant Depression,” Psychiatric Journal of the University of Ottawa 15 (1990): 156–58.
A useful general review of rate of effectiveness is in Spiegel, Psychopharmacology.
5. See, for example, J. Hall, “Fluoxetine: Efficacy Against Placebo and by Dose—An Over view,” British Journal of Psychiatry supplement 3 (1988): 59–63.
6. This little-known story is narrated by John Cade in his “The Story of Lithium,” in Ayd and Blackwell, Discoveries in Biological Psychiatry, 218–29.
7. Lithium is more effective on the manic side of manic-depressive illness than it is for the depression. It is preventative of manic episodes as well, if taken regularly. It has toxic side effects (both cardiac and gastrointestinal) and so must be monitored carefully. See R. Sack and E. De Fraites, “Lithium and the Treatment of Mania,” in Barchas et al., Psychopharmacology, 208–25. One of the major problems of prescribing lithium is that many manic patients won’t take it. They feel good—very good—and they often don’t want medication.
See also H. Johnson, K. Olafsson, J. Andersen, P. Plenge, et al., “Lithium Every Second Day,” American Journal of Psychiatry 146 (1989): 557, for a recent study on effective administration.
8. The discovery and early history of the minor tranquilizers (as the anxiolytics are called) is narrated candidly by Frank Berger, “Anxiety and the Discovery of Tranquilizers,” and by Irvin Cohen, “The Benzodiazepines,” in Ayd and Blackwell, Discoveries in Biological Psychiatry, 115–29 and 130–41, respectively.
9. The most optimistic recent estimate I know of concerning “percentage effectiveness” of the antipsychotics is: complete eradication of delusions and hallucinations, 22.5 percent; partial improvement, 60 percent; no improvement, 17.5 percent. This is from J. Chandler and G. Winokur, “How Antipsychotic Are the Antipsychotics? A Clinical Study of the Subjective Antipsychotic Effect of the Antipsychotics in Chronic Schizophrenia,” Annals of Clinical Psychiatry 1 (1989): 215–20.
10 I volunteered to be a subject for David Rosenhan’s classic study “On Being Sane in Insane Places,” Science 179 (1973): 250–58. Rosenhan and I went into Norristown State Hospital together. He was ill-treated, as expected. I was wonderfully treated. This tale is worth a whole chapter itself—but in some other volume.
11 J. Wegner, F. Catalano, J. Gibralter, and J. Kane, “Schizophrenics with Tardive Dyskinesia,” Archives of General Psychiatry 42 (1985): 860–65; ACNP-FDA Task Force, “Medical Intelligence—Drug Therapy,” New England Journal of Medicine 130 (1973): 20–24. Fine recent coverage of tardive dyskinesia is in C. Gualtieri, Neuropsychiatry and Behavioral Pharmacology (New York: Springer-Verlag, 1991).
12 G. Cooper, “The Safety of Fluoxetine—An Update,” British Journal of Psychiatry 153 (1988): 77–86; J. Wernicke, “The Side-Effect Profile