Monday, April 30, 2007

Dropping acid

In the May issue of Harper's you'll find an insightful essay by Gary Greenberg entitled "Manufacturing depression: A journey into the economy of melancholy." Greenberg, a psychotherapist and freelance writer, has previously written equally engaging pieces in Harper's, Mother Jones, Wired, The New Yorker, and McSweeney's.

"Manufacturing depression" tells the story of Greenberg's experience as an enrollee in a psychopharmacology study at Massachusetts General, in which the effectiveness of omega-3 fatty acids in treating major depression was being tested.

His story with the Mass General researchers begins with an evaluation of depression to see if he was an appropriate fit for the study. Greenberg thought that he'd meet the criteria for what the DSM calls minor depression, "figur[ing] anyone paying sufficient attention was bound to show the two symptoms out of the nine". Heavily abbreviated, those criteria are:
  1. depressed mood nearly every day
  2. markedly diminished interest in activities nearly every day
  3. significant weight loss or weight gain
  4. insomnia or hypersomnia nearly every day
  5. psychomotor agitation or retardation nearly every day
  6. fatigue or loss of energy nearly every day
  7. feelings of worthlessness or excessive guilt nearly every day
  8. diminished ability to concentrate, nearly every day
  9. recurrent thoughts of death, suicidal thoughts
To his surpise, Greenberg is deemed ineligible for the minor depression study because he meets the criteria for major depression (at least five of the symptoms above). He's whisked away into the omega-3 study, and insightful deconstruction of psychiatry ensues.

I won't spoil the rest of the essay; instead here are my two cents on one of Greenberg's relatively minor critiques of the experience. As in any pharmacological trial, the omega-3 fatty acid study is a double-blind, placebo-controlled study; he doesn't know whether or not he's getting the omega-3 or placebo, and nor do the researchers he's interacting with. The thing that surprised me was that at the end of the study, the researchers still could not "break the blind," i.e., tell him which one he was taking.

Evidently the argument for not breaking the blind on each patient's completion of the study is that otherwise, the researchers who represent the "double" part of the blind could detect a pattern across participants.

Surely, if this is the only concern, there are ways to get around this problem, such as having another researcher in the lab, or the pharmacologist who knows the assignments, notify the participant in some other way than through the researcher who administers the examinations?

In the end, Greenberg does find out which one he took, but only after mailing the rest of his pills off to the lab.

Recommended reading:

Greenberg, G. (2007, May). Manufacturing depression: A journey into the economy of melancholy. Harper's, 314, 35-46.

Listen to WBUR's On Point radio program related to the article

Spiegel, A. (2005, January). The dictionary of disorder: How one man revolutionized psychiatry. The New Yorker.


AlvaroF said...

Hello "Neurozone", I found you through Neurophilosopher's blog. Just wanted to say Hi, since we are in SF too, and mention we have an event with Dr. Elkhonon Goldberg on May 16th. If you're interested, just drop me a line (alvaro at sharpbrains dot com) and i will send more info, or you can check our blog

Neurozone said...

Thank you, Alvarof. I have been meaning to check out "The Executive Brain" and this might be a good excuse.

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