quarta-feira, 28 de setembro de 2011

In treatment, episode 28, season 03

In treatment, episode 27, season 03

In treatment, episode 26, season 03

In treatment, episode 25, season 03

In treatment, episode 24, season 03

In treatment, episode 23, season 03

In treatment, episode 22, season 03

In treatment, episode 21, season 03

In treatment, episode 20, season 03

In treatment, episode 19, season 03

In treatment, episode 18, season 03

In treatment, episode 17, season 03

In treatment, episode 16, season 03

In treatment, episode 15, season 03

In treatment, episode 14, season 03

In treatment, episode 13, season 03

In treatment, episode 12, season 03

In treatment, episode 11, season 03

In treatment, episode 10, season 03

In treatment, episode 09, season 03

In treatment, episode 08, season 03

In treatment, episode 07, season 03

In treatment, episode 06, season 03

In treatment, episode 05, season 03

In treatment, episode 04, season 03

In treatment, episode 03, season 03

In treatment, episode 02, season 03

In treatment, episode 01, season 03

sexta-feira, 23 de setembro de 2011

In treatment, episode 35, season 02

In treatment, episode 34, season 02

In treatment, episode 33, season 02

In treatment, episode 32, season 02

In treatment, episode 31, season 02

In treatment, episode 30, season 02

In treatment, episode 29, season 02

In treatment, episode 28, season 02

In treatment, episode 27, season 02

In treatment, episode 26, season 02

In treatment, episode 25, season 02

In treatment, episode 24, season 02

In treatment, episode 23, season 02

In treatment, episode 22, season 02

In treatment, episode 21, season 02

quarta-feira, 21 de setembro de 2011

In treatment, episode 10, season 02

In treatment, episode 09, season 02

In treatment, episode 08, season 02

In treatment, episode 07, season 02

In treatment, episode 06, season 02

In treatment, episode 05, season 02

In treatment, episode 04, season 02

In treatment, episode 03, season 02

In treatment, episode 02, season 02

In treatment, episode 01, season 02

In treatment, episode 43, season 01

In treatment, episode 42, season 01

In treatment, episode 41, season 01

In treatment, episode 40, season 01

In treatment, episode 39, season 01

In treatment, episode 38, season 01

In treatment, episode 37, season 01

In treatment, episode 36, season 01

In treatment, episode 35, season 01

In treatment, episode 34, season 01

In treatment, episode 33, season 01

In treatment, episode 32, season 01

In treatment, episode 31, season 01

In treatment, episode 30, season 01

In treatment, episode 29, season 01

In treatment, episode 28, season 01

In treatment, episode 27, season 01

In treatment, episode 26, season 01

In treatment, episode 25, season 01

In treatment, episode 24, season 01

In treatment, episode 23, season 01

In treatment, episode 22, season 01

In treatment, episode 21, season 01

segunda-feira, 12 de setembro de 2011

The political power of literature, Riz Khan



Can literature inspire revolutions? What role do artists and intellectuals play on the frontline of popular uprisings?

quinta-feira, 1 de setembro de 2011

The loss of sadness: how Psychiatry transformed normal sorrow into Depressive Disorder, Allan V. Horwitz

Depression has become the single most commonly treated mental disorder, amid claims that one out of ten Americans suffer from this disorder every year and 25% succumb at some point in their lives. Warnings that depressive disorder is a leading cause of worldwide disability have been accompanied by a massive upsurge in the consumption of antidepressant medication, widespread screening for depression in clinics and schools, and a push to diagnose depression early, on the basis of just a few symptoms, in order to prevent more severe conditions from developing.

In The Loss of Sadness, Allan V. Horwitz and Jerome C. Wakefield argue that, while depressive disorder certainly exists and can be a devastating condition warranting medical attention, the apparent epidemic in fact reflects the way the psychiatric profession has understood and reclassified normal human sadness as largely an abnormal experience. With the 1980 publication of the landmark third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), mental health professionals began diagnosing depression based on symptoms—such as depressed mood, loss of appetite, and fatigue—that lasted for at least two weeks. This system is fundamentally flawed, the authors maintain, because it fails to take into account the context in which the symptoms occur. They stress the importance of distinguishing between abnormal reactions due to internal dysfunction and normal sadness brought on by external circumstances. Under the current DSM classification system, however, this distinction is impossible to make, so the expected emotional distress caused by upsetting events-for example, the loss of a job or the end of a relationship- could lead to a mistaken diagnosis of depressive disorder. Indeed, it is this very mistake that lies at the root of the presumed epidemic of major depression in our midst.

In telling the story behind this phenomenon, the authors draw on the 2,500-year history of writing about depression, including studies in both the medical and social sciences, to demonstrate why the DSM's diagnosis is so flawed. They also explore why it has achieved almost unshakable currency despite its limitations. Framed within an evolutionary account of human health and disease, The Loss of Sadness presents a fascinating dissection of depression as both a normal and disordered human emotion and a sweeping critique of current psychiatric diagnostic practices. The result is a potent challenge to the diagnostic revolution that began almost thirty years ago in psychiatry and a provocative analysis of one of the most significant mental health issues today.

Prozac at 20



Little pill, big difference: the pros and cons of Prozac at 20.

GUESTS

Ariel Dalfen is a psychiatrist at Mount Sinai Hospital, and a lecturer in the Department of Psychiatry at the University of Toronto.

Norman Doidge is a Toronto research psychiatrist and author of The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.

Daniel Gorman is staff psychiatrist at The Hospital for Sick Children, and he is also an assistant professor in the Department of Psychiatry at the University of Toronto.

Jerome Wakefield is a professor in the School of Social Work at New York University, and author, with Allan Horwitz, of The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder.

Rethinking Psychiatric Care, Robert Whitaker



Rethinking Psychiatric Care: If We Follow the Scientific Evidence, What Must We Do To Better Promote Long-term Recovery?

During the past 20 years, the number of adults in the United States on federal disability rolls due to mental illness has more than tripled, rising from 1.25 million people in 1987 to more than four million in 2007. The number of children receiving a federal disability check due to severe mental illness increased 35-fold during this period, rising from 16,200 to 561,569.

This disability data necessarily begs a question, one that our society desperately needs to investigate. Could our drug-based paradigm of care, in some unforeseen way, be fueling this epidemic of disabling illness? What does the scientific literature show? Do psychiatric medications improve or worsen long-term outcomes? Does their use decrease or increase the risk of long-term disability? And what is happening to children prescribed
psychiatric medications over the long-term? Are they faring well?

The disability numbers also tell us that we need to look to develop new solutions. In Europe, there are providers of psychiatric services that have begun using psychiatric medications in a selective, limited manner and are now reporting very good outcomes. How can we adopt these methods here?

Anatomy of an epidemic: magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America, Robert Whitaker

In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical mystery: Why has the number of disabled mentally ill in the United States tripled over the past two decades? Every day, 1,100 adults and children are added to the government disability rolls because they have become newly disabled by mental illness, with this epidemic spreading most rapidly among our nation’s children. What is going on?Anatomy of an Epidemic challenges readers to think through that question themselves. First, Whitaker investigates what is known today about the biological causes of mental disorders. Do psychiatric medications fix “chemical imbalances” in the brain, or do they, in fact, create them? Researchers spent decades studying that question, and by the late 1980s, they had their answer. Readers will be startled—and dismayed—to discover what was reported in the scientific journals.Then comes the scientific query at the heart of this book: During the past fifty years, when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? Or did they find that these medications, for some paradoxical reason, increase the likelihood that people will become chronically ill, less able to function well, more prone to physical illness? This is the first book to look at the merits of psychiatric medications through the prism of long-term results. Are long-term recovery rates higher for medicated or unmedicated schizophrenia patients? Does taking an antidepressant decrease or increase the risk that a depressed person will become disabled by the disorder? Do bipolar patients fare better today than they did forty years ago, or much worse? When the National Institute of Mental Health (NIMH) studied the long-term outcomes of children with ADHD, did they determine that stimulants provide any benefit? By the end of this review of the outcomes literature, readers are certain to have a haunting question of their own: Why have the results from these long-term studies—all of which point to the same startling conclusion—been kept from the public? In this compelling history, Whitaker also tells the personal stories of children and adults swept up in this epidemic. Finally, he reports on innovative programs of psychiatric care in Europe and the United States that are producing good long-term outcomes. Our nation has been hit by an epidemic of disabling mental illness, and yet, as Anatomy of an Epidemic reveals, the medical blueprints for curbing that epidemic have already been drawn up.


Antidepressants: the emperor's new drugs?


Antidepressants are supposed to be the magic bullet for curing depression. But are they? I used to think so. As a clinical psychologist, I used to refer depressed clients to psychiatric colleagues to have them prescribed. But over the past decade, researchers have uncovered mounting evidence that they are not. It seems that we have been misled. Depression is not a brain disease, and chemicals don't cure it.My awareness that the chemical cure of depression is a myth began in 1998, when Guy Sapirstein and I set out to assess the placebo effect in the treatment of depression. Instead of doing a brand new study, we decided to pool the results of previous studies in which placebos had been used to treat depression and analyze them together. What we did is called a meta-analysis, and it is a common technique for making sense of the data when a large number of studies have been done to answer a particular question. It is rare for a study to focus on the placebo effect--or on the effect of the simple passage of time, for that matter. So where were we to find our placebo data and no-treatment data? We found our placebo data in clinical studies of antidepressants. All told, we analyzed 38 published clinical trials involving more than 3,000 depressed patients. What we found came as a big surprise. It turned out that 75 percent of the antidepressant effect was also produced by placebos - sugar pills with no active ingredients that are used to control the effects of hope and expectation in clinical trials. In other words, most of the improvement seen in patients given antidepressants was a placebo effect.Worse yet, it seemed that even the small seeming drug effect might have really been a placebo effect. These studies were supposed to be double-blind. That means that neither the patients nor their doctors were supposed to know whether they had been given the real drug or a placebo. As it turned out, most of them were able to figure out which they were given, especially those who had been given the real drug. Antidepressants have side effects, and when a patient experiences these side effects, they know that they are in the drug group rather than the placebo group. That knowledge could be responsible for the small apparent advantage of drug over placebo.As you might imagine, our study was very controversial. How could these drugs, which account for about 15 percent or all prescriptions in the US, be placebos? The antidepressants we studied had been approved by the FDA. If they were just placebos, why did the FDA approve them?
To answer these questions, my colleagues and I used the Freedom of Information Act to get the data that the drug companies had sent to the FDA in the process of getting their medications approved. What we found was even more shocking that what our 1998 study had shown. The difference between drug and placebo was even smaller in the data sent to the FDA than it was in the published literature. More than half of the clinical trials sponsored by the pharmaceutical companies showed no significant difference at all between drug and placebo. What they did find was differences in side effects, like nausea and sexual dysfunction, produced by antidepressants; and the FDA later determined that SSRIs, the most common type of antidepressants, actually increases the risk of suicide for children, adolescents and young adults.So why did the FDA approve these drugs? All they require is that there are two trials showing a statistical difference between drug and placebo. The drug company might have conducted 10 trials, and most have them might have failed to show positive results. Still, if there are two trials that have been successful, the antidepressant can be approved. And even in these two successful trials, it doesn't matter how large the drug effect is. It can be small enough to make no real difference in people's lives. It doesn't have to be clinically significant; It just has to be statistically significant. Fortunately there are alternatives to treatment with dangerous but largely ineffective drugs. Psychotherapy works, and some types of therapy have been shown to be much more effective than antidepressants over the long run. Physical exercise also works, and at least for mildly depressed people, there are self-help books like David Burns's Feeling Good, that have been tested in clinical trials and found to be effective. So if you're feeling blue, you may not have to take pills to get better. Instead, talk to your doctor about safer and more effective alternative treatments.

Irving Kirsch is Professor of Psychology at the University of Hull in the UK and author of "The Emperor's New Drugs: Exploding the Antidepressant Myth" (Basic Books, 2010). Irving Kirsch is professor of psychology the University of Hull. He has published 10 books and more than 200 scientific journal articles and book chapters on placebo effects, antidepressant medication, hypnosis, and suggestion. His meta-analyses on the efficacy of antidepressants were covered extensively in the international media and influenced official guidelines for the treatment of depression in the United Kingdom. His book, The Emperor’s New Drugs: Exploding the Antidepressant Myth, was published by Random House in the UK and Basic Books in the US.