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February 27, 2008

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Swivelchair

Hi JD -
This is a whole different paradigm for the biopharma business. I think we're moving from blockbuster drugs to personalized medicine.

The missing link is the genetic (or other) testing to see who will be most responsive to the drug.

The other thing about Prozac is that it took the shame out of getting your mental health treated. People complain, but I think the Prozac (and their ilk) direct to consumer adverts were a boon for patients -- many MD's just didn't take mental health seriously.

One more thing -- depression untreated changes the shape of your brain. And the wiring. Just like PTSD. I don't think people realize this, so studies of psycho-therapy effectiveness show people improve over time -- but how much of that is due to the therapy and how much of that is due to removing the stress on the brain and the brain tissue/cells healing? Seems like an ambiguous result to me.

Jeremiah Dwyer

Hey Swivel,

Good points. But I think the effectiveness of psychotherapy can be quanitifed by several observations (no links or citings, but I'm sure I'm on solid ground here):

1) The improvement of groups receiving therapy vs. control groups on a wait list or no treatment (if it is simply brain recovery, should show same results).

2) Effectiveness of therapy in preventing relapse (including against individuals on SSRIs)

3) The fact that at least 50% of depression is the result of cognitive and interpersonal, rather than biological, factors - manipulate the psychological (i.e. cognitive) and interpersonal factors, manipulate the outcome (for example, improved social connectiveness, better choices, increased comfort with healthy risk-taking, etc). Improvement in those areas will lead to better mood, since depression is made up of that stuff (well, at least 50% anyway)

4) This one I'm less sure about, but I believe I've read documentation that participation in therapy will show altered brain structure versus controls - therapy is impacting the wiring positively as well.

Good stuff, I'll definitely want to keep an eye out for more research on these topics!

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