Questions?   Comments?    I'd love to hear from you!      > > >
Good Mood Bad Mood
  • Home
  • Purchase
  • Endorsements
  • Resources
  • Contact
  • Blog

Anti-Depressants & Side Effects: Being Positive Doesn’t Always Mean I Agree!

2/28/2014

0 Comments

 
In recent days a friend told me that sometimes I am too negative when it comes to the contributions of psychiatry and psychology to the care of those who struggle with worry and sadness. And, I must admit that I often find myself telling readers about medications and therapies that really do not seem to work well.  One subject that my friend said that I was out of balance on was the side effects of anti-depressant medications. He said that biblical counselors over emphasize the side effects and under estimate the benefits of taking these medicines.

Well, I value my friend and his opinion. But, if medicine is going to be effective and helpful, our opinions about it must be founded in scientific fact. This week I read an article that dealt with the incidence of side effects among patients who take antidepressants.[i] To start with the positive, the study looked at the incidence of side effects in 1829 patients living in New Zealand. Eighty percent of the patients reported that they were helped by the medication.

However, the patients also reported that they had side effects. The authors noted that “while the biological side-effects of antidepressants, such as weight gain and nausea, are well documented, the psychological and interpersonal effects have been largely ignored or denied. They appear to be alarmingly common.” The side effects reported were significant.

In the 18 to 25 year age group, half reported suicidal feelings and in the total group one third reported suicidal feelings. Sexual difficulties were reported by 62%, and feeling emotionally numb by 60%. Other adverse effects included not feeling like myself in 52%, a reduction of positive feelings in 42%, caring less about others in 39%. Withdrawal effects were reported in 55%. [ii]

So, there it is the positive and the negative. The negative looms larger perhaps than my friend or any of us were aware. Side effects with the current crop of antidepressant medications are frequent, troublesome and sometimes severe. The author, Professor John Read said, “Our finding that over a third of respondents reported suicidality as a result of taking the antidepressants suggests that earlier studies may have underestimated the problem.”

I have no way of knowing whether or not biblical counselors overestimate the side effects of antidepressants. No one has done any research about it. I do remember once when a representative of an antidepressant manufacturer came to my office and told me that a new medication had almost no side effects. I did not laugh out loud, but I did chuckle inside. Somehow I think like Professor Read that the side effects of antidepressants have been minimized.

On the other hand we do know by research that the benefits have been over estimated.[iii] Whenever a patient considers taking any kind of medicine there are two important things they need to know. How effective is the treatment. In real numbers how often does this medicine cure the disease? And, equally important, in real numbers how often do patients suffer side effects? With that kind of information we can make decisions to take or not take medicine based on scientific fact not on emotion.
[i] Psychological side-effects of anti-depressants worse than thought. ScienceDaily, February 25, 2014.

 [ii] Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants, Psychiatry Research, 2014 DOI: 10.1016/j.psychres.2014.01.042 John Read, Claire Cartwright, Kerry Gibson.

[iii] See chapters 1-6, Good Mood Bad Mood, Shepherd Press.

0 Comments

To Sleep, To Dream: Sleep Disordered Breathing & Psychiatric Disorders

2/21/2014

0 Comments

 
It is not uncommon today to have patients come to the office with several diagnoses from several physicians. It is just as common for them to be taking several medications prescribed by different providers who do not always know what the other doctor is doing. And, at times it is up to me to help them sort it out as their family physician.

I have seen several people who have come to me being treated for adult Attention Deficit Hyperactivity Disorder who were being treated for obstructive sleep apnea at the same time. Almost always the symptoms of ADHD predate the discovery of the obstructive sleep apnea. Generally neither the sleep specialist nor the ADHD provider knows about the others existence. It is important because if they did, they might change how they treated the patient.

This week an interesting article in the Psychiatric Times pointed out something that I have been teaching about for years.[i] An important part of counseling is a trip to a trusted doctor and a thorough medical work up. There are any number of medical diseases that can and do affect emotions and behavior. It is important to find them and treat them in the best way possible. It is also very important that at least one physician knows all the diagnosis and treatments that the patient is receiving.

The article examined the role that abnormal breathing during sleep plays in changing how we feel and act. “Sleep disordered breathing signs and symptoms overlap with mood, anxiety and other psychiatric disorders. In some cases they may masquerade as these disorders…” Problems such as depression, anxiety, Attention Deficit, a decline in the ability to think, irritability, and difficulty dealing with problems in life all may find their cause in a patient’s inability to breathe normally while sleeping.

The most common cause of sleep disordered breathing in North America is Obstructive Sleep Apnea (OSA). When asleep the patient’s airway is either completely or partially blocked. This requires the individual to reposition themselves in order to breathe and keeps them from achieving normal restorative sleep. Generally, those with OSA are known for their snoring. It can occur in children with large obstructive tonsils and in adults who are overweight. It occurs in thin adults but is much less common. A good question is “has your spouse ever heard you stop breathing while you are sleeping.”

Diseases that can be diagnosed in people who have Sleep Disorder Breathing include anxiety, depression, mood disorders, and Attention Deficit hyperactivity disorder. I have seen many individuals through the years who have been diagnosed with ADHD initially only to be found to have obstructive sleep apnea. Correction of the sleep disorder will most often correct the psychiatric diagnosis too.

There are many important questions to ask in a first counseling session. One them ought to be “how are you sleeping?” For counselees who are not sleeping normally a visit to a trusted doctor is very important
[i] Clinical features of  Sleep-Disordered Breathing, Feb 4 2014.

 http://www.psychiatrictimes.com/sleep-disorders/clinical-features-sleep-disordered-breathing?GUID=9210862A-4B1C-484B-9F75-109A6B3AA270&rememberme=1&ts=18022014

0 Comments

What Makes a Biblical Counselor Biblical?

2/16/2014

0 Comments

 

David Murray has written a blog that mentions me and asks the question can anyone be a Biblical Counselor without being part of the Biblical Counseling Movement. You can his blog “When Friends Disagree” at http://headhearthand.org/blog/2014/02/13/when-friends-disagree/#comment-45128 .

David poses an interesting question and here is my answer.

David,

Friends? Yes! Brothers for certain! Can anyone be a Biblical Counselor without being a part of the Biblical Counseling Movement? I suppose that it just as likely as someone being a Christian without being a Baptist or a Methodist or a Presbyterian. J

When I started this counseling journey I suspect that I was probably right in the middle of the road. I was certainly not in the Biblical Counseling movement, but I was not happy with the outcomes that I was seeing with a counseling format that attempted to merge the “best of” secular psychology, medical treatment and my view of Christian counseling. It is interesting to me that you say that the results you have seen with CBT have in part led you to the position that you hold.

My experience was in the opposite direction. After about 10 years of doing my best to integrate medicine, secular counseling, and the Bible, I was introduced to better outcomes with Biblical counseling. My brother had taken training and came back pastoring and counseling in a remarkably different way. That led me to go for the same training.

When I teach Biblical counseling, I tell students that good people do disagree about where to draw the line between medical and spiritual issues. And, I tell them that when we do disagree, we need to be gracious when we speak about things that fall in the Romans 14 arena. But, there are some things that fall outside of that arena for anyone who would identify him or herself as a Biblical counselor. I am glad that you say that having read the BCC documents that you agree with them 100%. That is a good place to start.

I do not want to turn this comment into a comprehensive statement about what I believe makes a Biblical counselor biblical. So I will note one thing and quit. It is a quote that I read from R.C. Sproul. “"It is your duty to believe and to teach what the Bible teaches, not what you want it to teach."

 For me that means that I am not at liberty to agree with a secular concept that is identified as scientific when it disagrees with scripture. As I tell students, I will never call anything a disease that the Bible calls a sin. At the same time, I also tell them that I will never call anything sin unless the Bible specifically does. I will not attempt to enforce my personal preferences on people with the weight of scripture.

I think that is a good place to start for anyone who wants to identify themselves as a Biblical counselor.

 

0 Comments

Schizophrenia. Cognitive Behavioral Therapy, & Helping Relationships

2/10/2014

0 Comments

 
David Murray has posted a blog[i] that reviews an article about the effectiveness of Cognitive Behavioral Therapy for the treatment of schizophrenics who refuse to take the anti-psychotic medication.  It is an interesting article in the Lancet that a documents a study in which CBT was compared to the outcome of treatment with medication.[ii]  In the study those treated with medicine and those who underwent cognitive therapy without medicine seemed to do about the same. It is an interesting study which is offered to show the value of CBT. But, the study has a flaw. As I read the original study I saw a comment article off on the right border and I read that one too. The following is my reply to David’s comments on the original article.

“Hello David, It does not look like anyone is going to say too much about this study so I will. As the authors note, no one will recommend CBT to treat schizophrenia alone. The article is an interesting parallel to depression, medical treatment and biblical counseling. The idea of treating schizophrenia with only CBT talk therapy would seem to most an outrageous idea.
What did catch my eye was a comment article to the right of the abstract. The comment article makes an interesting point about the study.


"First, the study did not have a placebo intervention. The potential effect of this limitation should not be underestimated because placebo effects can be large in schizophrenia trials, and have contributed to failed studies of new drug treatments for schizophrenia. The absence of placebo might be important in this trial because, although the assessors were masked to group allocation, patients were not, and the outcome measures rely on patient self-report. Although these measures are standard in schizophrenia trials, the risk of reporting biases might be large for cognitive therapy, because it explicitly focuses on the patient and therapist forming a close collaborative relationship.”[iii]

As with any intervention in the life of a struggler the relationship may be the key. Just having someone to talk to without regard to what they might discuss may have a profound effect on their outcome whether they are schizophrenic or depressed.

Maybe that is the most important thing we have to offer either the schizophrenic or the depressed individual; a human being with whom to talk.” (end of my comment)

While the original study is flawed and as a result falls short of proving that CBT is uniquely beneficial in schizophrenia, the study does show one important thing. Counseling of any sort will benefit from a relationship built in trust between the counselor and the counselee.  As Paul would say in 2 Corinthians 7:6, “God who comforts the depressed, comforted us by the coming of Titus.”  The best counseling is found in strong, biblically supportive relationships.  


[i] http://headhearthand.org/blog/2014/02/10/schizophrenia-helped-by-cbt/#comment-44778

 

[ii] Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial
Prof Anthony P Morrison D Clin Psy,Prof Douglas Turkington MD,Melissa Pyle BSc,Helen Spencer BA,Alison Brabban D Clin Psy,Prof Graham Dunn PhD,Tom Christodoulides D Clin Psy,Rob Dudley PhD,Nicola Chapman D Clin Psy,Pauline Callcott MSc,Tim Grace PG Dip,Victoria Lumley PG Dip,Laura Drage MPhil,Sarah Tully MSc,Kerry Irving BSc,Anna Cummings BSc,Rory Byrne BSc,Prof Linda M Davies MSc,Paul Hutton D Clin Psy
The Lancet - 6 February 2014
DOI: 10.1016/S0140-6736(13)62246-1


 

[iii] Cognitive therapy: at last an alternative to antipsychotics?
Oliver Howes
The Lancet – 6 February 2014
DOI: 10.1016/S0140-6736(13)62569-6


 

0 Comments

Counseling Wars? I don't think so.

2/7/2014

4 Comments

 



David Murray and Bob Kellemen have been having a conversation about Biblical counseling and medication. Bob writes at http://biblicalcounselingcoalition.org/


I was mentioned in the last article that David Murray wrote and I decided to blog about it. You can find David’s blog from today at www.HeadHeartHand.org


Hello Pastor Murray,

I don’t know you as we have never met. I suppose that must change now since you have mentioned me in print. I am Charles Hodges the author of Good Mood Bad Mood. I have practiced medicine for 38 years now as a family physician and I write the prescriptions for the anti depressants that your friend was going to discuss with his doctor. I have been teaching and counseling from a Biblical viewpoint for a couple of decades. I am not Ken Ham. Ken Ham is far better suited for that than I am. J

I do think we should get to know each other. I think there are many people like me in the Biblical Counseling movement and if you knew me better you would know them better too.  So, let’s take a run at it.

Yes, there is controversy (You used the word war) going on in the field of depression. Frankly, the argument is not yours. It is happening in my field of medicine. And, researchers are currently airing their disagreements about the effectiveness of antidepressants as they are being used today. There is also a considerable argument going on about the diagnosis of depression and DSM criteria whereby it is made. This is not an argument in Biblical counseling. This is an argument among psychologists and psychiatrists without regard to religion! I outline that research in my book. I did so because current research would indicate that the diagnosis of depression is ambiguous and applied far too often to people who are grieving loses.

We in the medical profession have caused this by consenting to a process of making a diagnosis of a disease (depression) with no means to validate it. The chemical imbalance theory of depression is fading because after 50 years of looking there is no objective scientific evidence that it exists.  This is not an opinion arrived at from examining the scriptures or biblical counseling folklore. It is the current statement of the scientific literature and I wrote about it in my book with abundant footnotes.

Perhaps it is true that many of us in Biblical counseling view the “observations of secular psychiatry” with skepticism.  It is not because we are afraid of encountering scientific fact. It is as Ronald Reagan once said of his political opposition. It wasn’t so much that they were uniformed. Reagan said, “It's just that they know so many things that aren't so.” So it has been in the psychiatric part of medicine. We have been operating for 50 years with “facts” that are proving not to be true!  And, that it is good because, now we can start looking for a better answer. And that is what medicine needs today; a better definition of the changes at the cell level that cause depression.  If we get that we can make a better diagnosis and we can find better ways to treat.

If you are looking for evidence that someone in the Biblical counseling movement is reading current research and writing about it, I invite you to read my blog at goodmoodbadmood.com.  I write there every week about the science of medicine that applies to Biblical counseling.  A couple of weeks back I wrote about a fascinating study that showed that taking religion seriously made a huge (90%) difference in the risk a person faces for depression if he came from a family that had a history of it. This morning I posted about the connection between sleeping less than 6 hours a night and depression. This is current published research that I write about.

I note that you mention Ed Welch’s book, “Blame it on the Brain.” There is a good quote in that book that applies to this chronic recurring controversy over taking antidepressants. I remember that he said something to the effect that taking medicine for psychiatric disorders was not a matter of right or wrong. Instead it was a question of whether it was “wise or unwise.” In that sense I have been trying to tell people for 20 years that taking medicine for psychiatric diagnoses is a Romans 14 issue of Christian Liberty. I have also said that the idea that taking antidepressants is a right or wrong issue has been the wrong question. What we should have been asking was, “do these medicines work and are the side effects worth the benefit!” The research today does not clearly tell us that these medicines work very well for most of those who take them.

I have little use for debates. It is not that I fear the controversy, but I do not like arguing with my brothers and sisters. I have a family of pastors whose denomination enjoys inviting pastors of other denominations in for a good round of debating their theological differences. They asked me once if I would come and do it. I told them no!  When they asked me why, I said it was because I liked them.

So, I know that you are a brother and that we likely disagree about some things. But I suspect that if you knew me better, you would criticize me and those like me less. We should get together and talk about this. 




Charles Hodges M.D.













http://headhearthand.org/blog/2014/02/07/where-is-biblical-counselings-ken-ham/#comment-44483

4 Comments

Depression & Sleep: Should We Blame Edison or Ourselves?

2/6/2014

0 Comments

 
Light bulbs have become a modest fixation for me. I hate anything that approaches fluorescence with a passion. I grew up in an incandescent world courtesy of one of the world’s greatest inventors Thomas Edison. And, frankly I would have preferred to finish under the somewhat golden light of a glowing filament. Thanks to a government that outlawed my favorite light source, I have become a hoarder of incandescent bulbs.

By now you are wondering what depression has to do with light bulbs and Tom Edison. The answer is that Edison made it economically practical to stay up long after dark. Our bodies are made to cycle up when the sun rises and cycle down when it sets. Edison made it possible for us to fight against our circadian rhythm. As I write this it is dark outside and if there weren’t twenty-three light bulbs over head and a big screen television in the corner, I would probably be asleep. And, that would be normal.

What isn’t normal is that I will stay up and watch the 11:00pm news and then set my alarm for 5:45am to knock me out of bed so that I can get to work. That is 6hours and 15minutes of sleep and it isn’t enough. It is also may be a prescription for depression.

In a couple of studies published in the journal Sleep, researchers looked at the relationship between the number of hours people sleep and their risk for depression. One study of 4100 subjects between the ages of 11 to 17 found that sleeping less than 6 hours increased their risk of depression. Another study of twins with a family history of depression found that sleeping a normal amount of 7 to 9 hours cut the risk of depression from 53% to 27%.[i]

As we seek to help people who come for counseling with complaints of depression and anxiety, one of the most important questions we need to ask is “how much are you sleeping?” I routinely tell counselees and patients that I may not be able to tell them what is wrong with them unless they change their life habits and get 8 hours of sleep a night for at least 2 weeks. If they cannot do this on their own I send them to see their doctor for a good medical work up and appropriate medical care.

Most of us do not sleep nearly enough. And, it generally is not because we could not if we allowed the time. We have become a people who routinely burn the candle at both ends. Maybe, we would all be in a better mood if we just turned the light off and went to bed earlier.


[i][i] Both studies can be found in February 2014 issue of SLEEP. Vol37 issue 02.

Sleep duration and Depressive Symptoms: A Gene-Environment Interaction. Watson et al.

The Prospective Association between Sleep Deprivation and Depression among Adolescents. Roberts et al.

0 Comments

    Author

    Charles D Hodges Jr. MD
    I have been counseling people with mood problems and other family issues  for 25 years.  

    Archives

    December 2019
    November 2019
    October 2019
    January 2017
    October 2015
    April 2015
    February 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    May 2013
    April 2013
    March 2013
    February 2013
    January 2013

    Categories

    All

    RSS Feed

Powered by Create your own unique website with customizable templates.