3 ms·

One thing to note is that the study population consisted entirely of severely depressed people. As far as I've read about it, the current consensus seems to be

One thing to note is that the study population consisted entirely of severely depressed people. As far as I've read about it, the current consensus seems to be that the more severe the depression is, the more likely it is to respond to medical interventions as opposed to psychological/behavioral ones. This ties in to a broader understanding that depressive disorders are considerably heterogeneous and no single theory or treatment target is relevant to all cases. So while this may be a genuine breakthrough, I hope people don't get the idea that it's the cure for depression generally.

yboris 7y ago
> the more severe [a problem] is, the more likely it is to respond to [some shock] I think there's a generalizable pattern - regression to the mean. In psychiatry, ECT (Electroconvulsive therapy) seems to be very effective in some severe cases: https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894 https://www.mayoclinic.org/tests-procedures/electroconvulsiv... I'm hopeful that the Stanford technique becomes yet another tool we have to address some of the hardest-to-treat problems.
starpilot 7y ago
> As far as I've read about it, the current consensus seems to be that the more severe the depression is, the more likely it is to respond to medical interventions as opposed to psychological/behavioral ones. I've never heard this in my life, can you link? These test subjects were people with treatment-resistant depression though, which I have as well. My experience, along with others I've known with it, is that we're more likely to deal with nocebo effects. HN is tossing heaps of cynicism on this report but even for unblinded testing these results are remarkable. > “There’s never been a therapy for treatment-resistant depression that’s broken 55% remission rates in open-label testing,” said Nolan Williams, MD, assistant professor of psychiatry and behavioral sciences and a senior author of the study
- 0xcde4c3db 7y ago
  I suppose consensus might not be the right word; maybe something closer to bias or even superstition might be appropriate. But basically, I'm synthesizing my own view of several trends here. That being the case, I don't have a link that neatly sums this up. Perhaps this is even my own little hallucination. I'm only an expert by comparison to the general public, in the sense that I periodically try to survey the literature with the most open mind I can manage. But the components I'm thinking of are mostly: 1) A sense that antidepressants tend to work better the more severe the depression is. This often comes up as a counterpoint to the anti-antidepressant talking point that SSRIs "don't outperform placebo" (often, in turn, in reference to studies that directly or indirectly exclude or otherwise under-represent people with severe depression). 2) A sense that the more severe a person's condition is, the less likely that psychotherapy is to be effective, at least as a first-line treatment. There's a lot of heat over whether or why this is the case, with a common refrain among advocates of psychotherapy being that some people need antidepressant drugs temporarily in order to be able to "do the work" of psychotherapy. 3) A longstanding belief among various people in the field that "melancholic" depression is both more severe/treatment-resistant/chronic/personality-based and more amenable to biologically-oriented interventions. There is a particular thread of HPA-axis (hypothalamic-pituitary-adrenal) [1] dysfunction that has been a subject of research for decades and continues to attract interest, with a more specific clinical focus being the dexamethasone suppression test (e.g. [2]). [1] https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary... [2] https://www.ncbi.nlm.nih.gov/pubmed/27736954 https://www.ncbi.nlm.nih.gov/pubmed/27736954

yboris 7y ago

> the more severe [a problem] is, the more likely it is to respond to [some shock] I think there's a generalizable pattern - regression to the mean. In psychiatry, ECT (Electroconvulsive therapy) seems to be very effective in some severe cases: https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894 https://www.mayoclinic.org/tests-procedures/electroconvulsiv... I'm hopeful that the Stanford technique becomes yet another tool we have to address some of the hardest-to-treat problems.

starpilot 7y ago

> As far as I've read about it, the current consensus seems to be that the more severe the depression is, the more likely it is to respond to medical interventions as opposed to psychological/behavioral ones. I've never heard this in my life, can you link? These test subjects were people with treatment-resistant depression though, which I have as well. My experience, along with others I've known with it, is that we're more likely to deal with nocebo effects. HN is tossing heaps of cynicism on this report but even for unblinded testing these results are remarkable. > “There’s never been a therapy for treatment-resistant depression that’s broken 55% remission rates in open-label testing,” said Nolan Williams, MD, assistant professor of psychiatry and behavioral sciences and a senior author of the study

0xcde4c3db 7y ago
I suppose consensus might not be the right word; maybe something closer to bias or even superstition might be appropriate. But basically, I'm synthesizing my own view of several trends here. That being the case, I don't have a link that neatly sums this up. Perhaps this is even my own little hallucination. I'm only an expert by comparison to the general public, in the sense that I periodically try to survey the literature with the most open mind I can manage. But the components I'm thinking of are mostly: 1) A sense that antidepressants tend to work better the more severe the depression is. This often comes up as a counterpoint to the anti-antidepressant talking point that SSRIs "don't outperform placebo" (often, in turn, in reference to studies that directly or indirectly exclude or otherwise under-represent people with severe depression). 2) A sense that the more severe a person's condition is, the less likely that psychotherapy is to be effective, at least as a first-line treatment. There's a lot of heat over whether or why this is the case, with a common refrain among advocates of psychotherapy being that some people need antidepressant drugs temporarily in order to be able to "do the work" of psychotherapy. 3) A longstanding belief among various people in the field that "melancholic" depression is both more severe/treatment-resistant/chronic/personality-based and more amenable to biologically-oriented interventions. There is a particular thread of HPA-axis (hypothalamic-pituitary-adrenal) [1] dysfunction that has been a subject of research for decades and continues to attract interest, with a more specific clinical focus being the dexamethasone suppression test (e.g. [2]). [1] https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary... [2] https://www.ncbi.nlm.nih.gov/pubmed/27736954 https://www.ncbi.nlm.nih.gov/pubmed/27736954