SOMOS POEMAS DE DEUS.

Fazia eu ao Senhor a minha oração
Deus, por seu anjo pediu-me um poema sobre as
Belezas de toda a Criação
Quando escrevi falando do Sol,
Senti Suas mãos me aquecendo
Ao falar da lua senti
Sua ternura me envolvendo
Falando eu dos animais sentia-O me embalar como a uma criança Falando das árvores e das flores, senti
Seu sopro de esperança Falando das águas, senti
Seu mergulho em mim com
Seu mistério a me proteger
Falando do céu senti Seu azul a me acolher
Falando do fogo senti
Sua chama purificando-me o ser
Falando do ar senti
Seu sopro divino a renovar meu viver
Terminado o breve poema
Apresentei-Lhe tudo quanto escrevi
Ouvi-o então dizendo:
"Prossegue, tu não falaste de ti"

(do Mundo das Mulheres, postado por Regina).


Não deixe de saborear este gostoso prato.
venha para Blog Coletivo-Uma Interação de Amigos

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Antidepressant Sales Rise as Depression Falls

Antidepressant sales are rising in most Western countries, and they have been for at least a decade. Recently, we learned that the proportion of Americans taking antidepressants in any given year nearly doubled from 1996 to 2005.

The situation has been thought to be similar in the UK. But a hot-off-the-press paper in the British Medical Journal reveals some surprising facts about the issue: Explaining the rise in antidepressant prescribing.

The authors examined medical records from 1.7 million British patients in primary care (General Practice, i.e. family doctors.) They found that antidepressant sales rose strongly between 1993 and 2005, not because more people are taking these drugs, but entirely because of an increase in the duration of treatment amongst the antidepressant users. It's not that more people are taking them, it's that people are taking them for longer.

In fact, the number of people being diagnosed with depression and prescribed antidepressants has actually fallen over time. The rate of diagnosed depression remained steady from 1993 to about 2001, and then fell markedly, by about a third, up to 2005. This trend was seen in both men and women, but there were age differences. In 18-30 year olds, there was a gradual increase in diagnoses before the decrease. (Note that these graphs show the number of people getting their first ever diagnosis of depression in each year.)
The likelihood of being given antidepressants for a diagnosis of depression stayed roughly constant, at about 75-80% across the years. However, the average duration of treatment increased over time -

The change doesn't look like much, but remember that even a small change in the number of long-term users translates into a large effect on the total number of sales, because each long-term user takes a lot of pills. The authors conclude

Antidepressant prescribing nearly doubled during the study period—the average number of prescriptions issued per patient increased from 2.8 in 1993 to 5.6 in 2004. ... the rise in antidepressant prescribing is mainly explained by small changes in the proportion of patients receiving long term treatment.

Wow. I didn't see that coming, I'll admit. A lot of people, myself included, had assumed that rising antidepressant use was caused by people becoming more willing to seek treatment for depression. Or maybe that doctors were becoming more eager to prescribe drugs. Others believed that rates of clinical depression were rising.

There's no evidence for either of these theories in this British data-set. The recent fall in clinical depression diagnoses, following an increase in young people over the course of the 1990s, is especially surprising. This conflicts with the only British population survey of mental health, the APMS. The APMS found that rates of depression and mixed anxiety/depression increased between 1993 and 2000 in most age groups but least of all in the young, and little change 2000 to 2007. I trust this new data more, because population surveys almost certainly overestimate mental illness.

How does this result compare to elsewhere? In the USA, the average number of antidepressant prescriptions per patient per year rose from "5.60 in 1996 to 6.93 in 2005" according to a recent estimate. In this study yearly "prescriptions issued per patient increased from 2.8 in 1993 to 5.6 in 2004." So there's a major trans-Atlantic difference. In Britain, the length of use increased greatly, while in the US it only rose slightly, but from a higher baseline.

Finally, why has this happened? We can only speculate. Maybe doctors have become more keen on long-term treatment to prevent depressive relapse. Or maybe users have become more willing to take antidepressants long-term. Modern drugs generally have milder side effects than older ones, so this makes sense, although some people would say that this is just further proof that modern antidepressants are "addictive"...

Moore M, Yuen HM, Dunn N, Mullee MA, Maskell J, & Kendrick T (2009). Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database. BMJ (Clinical research ed.), 339 PMID: 19833707

Antidepressant Sales Rise as Depression Falls

Antidepressant sales are rising in most Western countries, and they have been for at least a decade. Recently, we learned that the proportion of Americans taking antidepressants in any given year nearly doubled from 1996 to 2005.

The situation has been thought to be similar in the UK. But a hot-off-the-press paper in the British Medical Journal reveals some surprising facts about the issue: Explaining the rise in antidepressant prescribing.

The authors examined medical records from 1.7 million British patients in primary care (General Practice, i.e. family doctors.) They found that antidepressant sales rose strongly between 1993 and 2005, not because more people are taking these drugs, but entirely because of an increase in the duration of treatment amongst the antidepressant users. It's not that more people are taking them, it's that people are taking them for longer.

In fact, the number of people being diagnosed with depression and prescribed antidepressants has actually fallen over time. The rate of diagnosed depression remained steady from 1993 to about 2001, and then fell markedly, by about a third, up to 2005. This trend was seen in both men and women, but there were age differences. In 18-30 year olds, there was a gradual increase in diagnoses before the decrease. (Note that these graphs show the number of people getting their first ever diagnosis of depression in each year.)
The likelihood of being given antidepressants for a diagnosis of depression stayed roughly constant, at about 75-80% across the years. However, the average duration of treatment increased over time -

The change doesn't look like much, but remember that even a small change in the number of long-term users translates into a large effect on the total number of sales, because each long-term user takes a lot of pills. The authors conclude

Antidepressant prescribing nearly doubled during the study period—the average number of prescriptions issued per patient increased from 2.8 in 1993 to 5.6 in 2004. ... the rise in antidepressant prescribing is mainly explained by small changes in the proportion of patients receiving long term treatment.

Wow. I didn't see that coming, I'll admit. A lot of people, myself included, had assumed that rising antidepressant use was caused by people becoming more willing to seek treatment for depression. Or maybe that doctors were becoming more eager to prescribe drugs. Others believed that rates of clinical depression were rising.

There's no evidence for either of these theories in this British data-set. The recent fall in clinical depression diagnoses, following an increase in young people over the course of the 1990s, is especially surprising. This conflicts with the only British population survey of mental health, the APMS. The APMS found that rates of depression and mixed anxiety/depression increased between 1993 and 2000 in most age groups but least of all in the young, and little change 2000 to 2007. I trust this new data more, because population surveys almost certainly overestimate mental illness.

How does this result compare to elsewhere? In the USA, the average number of antidepressant prescriptions per patient per year rose from "5.60 in 1996 to 6.93 in 2005" according to a recent estimate. In this study yearly "prescriptions issued per patient increased from 2.8 in 1993 to 5.6 in 2004." So there's a major trans-Atlantic difference. In Britain, the length of use increased greatly, while in the US it only rose slightly, but from a higher baseline.

Finally, why has this happened? We can only speculate. Maybe doctors have become more keen on long-term treatment to prevent depressive relapse. Or maybe users have become more willing to take antidepressants long-term. Modern drugs generally have milder side effects than older ones, so this makes sense, although some people would say that this is just further proof that modern antidepressants are "addictive"...

Moore M, Yuen HM, Dunn N, Mullee MA, Maskell J, & Kendrick T (2009). Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database. BMJ (Clinical research ed.), 339 PMID: 19833707

RECEBI MIMOS E SELOS.

OBRIGADOS MINHAS QUERIDAS AMIGAS.

Para a Sandra do Blog "Curiosa".

OBRIGADA ISA. VOCÊ É MARAVILHOSA.
TE AMO MINHA PORTUGUESA.

Um mimo... isa

UM LINDO PRESENTE DA MINHA AMIGA JULIANA DO BLOG BRAILLE DA ALMA.

http://brailledalma.blogspot.com
MUITO OBRIGADA AMIGA.

OBRIGADA MILLY
ESTE CANTINHO É MARAVILHOSO.

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AMEI OS PRESENTES.

Lindo este selinho que ganhei do blog Palavras Soltas.
http://anninhadoleonardo.blogspot.com/
Obrigada Anninha.
Mais um Selinho Meu Blog é um Encanto


OBRIGADA AMIGA.
AMO VISITAR O SEU TAMBÉM!!!

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GANHEI DA NANDE DO BLOG ORULHO DE SER.
2º vez bom demais receber um "Meme"

Indicada mais uma vez ehehehe para um "Meme" dessa vez

pela Nade do Blog Orgulho de Ser .

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Adorei demais

receber esse Presente de você Nade!

Obrigada pelo Carinho!

REPASSO A TODOS OS MEUS SEGUIDORES, ESTES LINDOS PRESENTES.
SÓ GOSTARIA QUE FOSSE FEITO O LINK, DE QUEMOEFERECEU/RECEBEU O PRESENTE.

UM PRESENTE PARA VOCÊ QUE SEMPRE PASSA POR AQUI.

QUE ESTA SEGUNDA FEIRA, SEJA REPLETA DE ALEGRIAS E EMOÇÕES.
AMO CADA UMA QUE PASSA POR AQUI.


VENHA FAZER PARTE DESSE CANTINHO Meus Mimos!

FELIZ E ABENÇOADO DOMINGO!

DESEJO A TODOS UM FELIZ DOMINGO E UM LINDO DIA ABENÇOADOS A TODOS.
QUE DEUS ABENÇOE A CADA UM.
QUE A PAZ REINE EM SEUS LARES E SUAS VIDAS.
UM ABRAÇO A TODOS.

FAÇA TUDO O QUE PUDER, PARA SER MUITO FELIZ HOJE E SEMPRE.
SÓ VOCÊ PODE.

TE ESPERO EM MEUS MIMOS PARA RECEBER UM LINDO PRESENTE.

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Deconstructing the Placebo

Last month Wired, announced that Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.

The article's a good read, and the basic story is true, at least in the case of psychiatric drugs. In clinical trials, people taking placebos do seem to get better more often now than in the past (paper). This is a big problem for Big Pharma, because it means that experimental new drugs often fail to perform better than placebo, i.e. they don't work. Wired have just noticed this, but it's been being discussed in the academic literature for several years.

Why is this? No-one knows. There have been many suggestions - maybe people "believe in" the benefits of drugs more nowadays, so the placebo effect is greater; maybe clinical trials are recruiting people with milder illnesses that respond better to placebo, or just get better on their own. But we really don't have any clear idea.

What if the confusion is because of the very concept of the "placebo"? Earlier this year, the BMJ ran a short opinion piece called It’s time to put the placebo out of our misery. Robin Nunn wants us to "stop thinking in terms of placebo...The placebo construct conceals more than it clarifies."

His central argument is an analogy. If we knew nothing about humour and observed a comedian telling jokes to an audience, we might decide there was a mysterious "audience effect" at work, and busy ourselves studying it...

Imagine that you are a visitor from another world. You observe a human audience for the first time. You notice a man making vocal sounds. He is watched by an audience. Suddenly they burst into smiles and laughter. Then they’re quiet. This cycle of quietness then laughter then quietness happens several times.

What is this strange audience effect? Not all of the man’s sounds generate an audience effect, and not every audience member reacts. You deem some members of the audience to be “audience responders,” those who are particularly influenced by the audience effect. What makes them react? A theory of the audience effect could be spun into an entire literature analogous to the literature on the placebo effect.

But what we should be doing is examining the details of jokes and of laughter -

We could learn more about what makes audiences laugh by returning to fundamentals. What is laughter? Why is “fart” funnier than “flatulence”? Why are some people just not funny no matter how many jokes they try?

And this is what we should be doing with the "placebo effect" as well -

Suppose there is no such unicorn as a placebo. Then what? Just replace the thought of placebo with something more fundamental. For those who use placebo as treatment, ask what is going on. Are you using the trappings of expertise, the white coat and diploma? Are you making your patients believe because they believe in you?

Nunn's piece is a polemic and he seems to be conclude by calling for a "post-placebo era" in which there will be no more placebo-controlled trials (although it's not clear what he means by this). This is going too far. But his analogy with humour is an important one because it forces us to analyse the placebo in detail.

"The placebo effect" has become a vague catch-all term for anything that seems to happen to people when you give them a sugar pill. Of course, lots of things could happen. They could feel better just because of the passage of time. Or they could realize that they're supposed to feel better and say they feel better, even if they don't.

The "true" placebo effect refers to improvement (or worsening) of symptoms driven purely by the psychological expectation of such. But even this is something of a catch-all term. Many things could drive this improvement. Suppose you give someone a placebo pill that you claim will make them more intelligent, and they believe it.

Believing themselves to be smarter, they start doing smart things like crosswords, math puzzles, reading hard books (or even reading Neuroskeptic), etc. But the placebo itself was just a nudge in the right direction. Anything which provided that nudge would also have worked - and the nudge itself can't take all the credit.

The strongest meaning of the "placebo effect" is a direct effect of belief upon symptoms. You give someone a sugar pill or injection, and they immediately feel less pain, or whatever. But even this effect encompasses two kinds of things. It's one thing if the original symptoms have a "real" medical cause, like a broken leg. But it's another thing if the original symptoms are themselves partially or wholly driven by psychological factors, i.e. if they are "psychosomatic".

If a placebo treats a "psychosomatic" disease, then that's not because the placebo has some mysterious, mind-over-matter "placebo effect". All the mystery, rather, lies with the psychosomatic disease. But this is a crucial distinction.

People seem more willing to accept the mind-over-matter powers of "the placebo" than they are to accept the existence of psychosomatic illness. As if only doctors with sugar pills possess the power of suggestion. If a simple pill can convince someone that they are cured, surely the modern world in all its complexity could convince people that they're ill.

[BPSDB]

Nunn, R. (2009). It's time to put the placebo out of our misery BMJ, 338 (apr20 2) DOI: 10.1136/bmj.b1568

Deconstructing the Placebo

Last month Wired, announced that Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.

The article's a good read, and the basic story is true, at least in the case of psychiatric drugs. In clinical trials, people taking placebos do seem to get better more often now than in the past (paper). This is a big problem for Big Pharma, because it means that experimental new drugs often fail to perform better than placebo, i.e. they don't work. Wired have just noticed this, but it's been being discussed in the academic literature for several years.

Why is this? No-one knows. There have been many suggestions - maybe people "believe in" the benefits of drugs more nowadays, so the placebo effect is greater; maybe clinical trials are recruiting people with milder illnesses that respond better to placebo, or just get better on their own. But we really don't have any clear idea.

What if the confusion is because of the very concept of the "placebo"? Earlier this year, the BMJ ran a short opinion piece called It’s time to put the placebo out of our misery. Robin Nunn wants us to "stop thinking in terms of placebo...The placebo construct conceals more than it clarifies."

His central argument is an analogy. If we knew nothing about humour and observed a comedian telling jokes to an audience, we might decide there was a mysterious "audience effect" at work, and busy ourselves studying it...

Imagine that you are a visitor from another world. You observe a human audience for the first time. You notice a man making vocal sounds. He is watched by an audience. Suddenly they burst into smiles and laughter. Then they’re quiet. This cycle of quietness then laughter then quietness happens several times.

What is this strange audience effect? Not all of the man’s sounds generate an audience effect, and not every audience member reacts. You deem some members of the audience to be “audience responders,” those who are particularly influenced by the audience effect. What makes them react? A theory of the audience effect could be spun into an entire literature analogous to the literature on the placebo effect.

But what we should be doing is examining the details of jokes and of laughter -

We could learn more about what makes audiences laugh by returning to fundamentals. What is laughter? Why is “fart” funnier than “flatulence”? Why are some people just not funny no matter how many jokes they try?

And this is what we should be doing with the "placebo effect" as well -

Suppose there is no such unicorn as a placebo. Then what? Just replace the thought of placebo with something more fundamental. For those who use placebo as treatment, ask what is going on. Are you using the trappings of expertise, the white coat and diploma? Are you making your patients believe because they believe in you?

Nunn's piece is a polemic and he seems to be conclude by calling for a "post-placebo era" in which there will be no more placebo-controlled trials (although it's not clear what he means by this). This is going too far. But his analogy with humour is an important one because it forces us to analyse the placebo in detail.

"The placebo effect" has become a vague catch-all term for anything that seems to happen to people when you give them a sugar pill. Of course, lots of things could happen. They could feel better just because of the passage of time. Or they could realize that they're supposed to feel better and say they feel better, even if they don't.

The "true" placebo effect refers to improvement (or worsening) of symptoms driven purely by the psychological expectation of such. But even this is something of a catch-all term. Many things could drive this improvement. Suppose you give someone a placebo pill that you claim will make them more intelligent, and they believe it.

Believing themselves to be smarter, they start doing smart things like crosswords, math puzzles, reading hard books (or even reading Neuroskeptic), etc. But the placebo itself was just a nudge in the right direction. Anything which provided that nudge would also have worked - and the nudge itself can't take all the credit.

The strongest meaning of the "placebo effect" is a direct effect of belief upon symptoms. You give someone a sugar pill or injection, and they immediately feel less pain, or whatever. But even this effect encompasses two kinds of things. It's one thing if the original symptoms have a "real" medical cause, like a broken leg. But it's another thing if the original symptoms are themselves partially or wholly driven by psychological factors, i.e. if they are "psychosomatic".

If a placebo treats a "psychosomatic" disease, then that's not because the placebo has some mysterious, mind-over-matter "placebo effect". All the mystery, rather, lies with the psychosomatic disease. But this is a crucial distinction.

People seem more willing to accept the mind-over-matter powers of "the placebo" than they are to accept the existence of psychosomatic illness. As if only doctors with sugar pills possess the power of suggestion. If a simple pill can convince someone that they are cured, surely the modern world in all its complexity could convince people that they're ill.

[BPSDB]

Nunn, R. (2009). It's time to put the placebo out of our misery BMJ, 338 (apr20 2) DOI: 10.1136/bmj.b1568