Tag Archives: anti-depressants

Clinical News You Can Use: EXPRESSED EMOTION AND RELAPSE. ARE YOU A HIGH EE PROFESSIONAL?

Research over about 30 years demonstrates a strong relationship between Expressed Emotion [EE] and relapse in many disorders, such as schizophrenia, anxiety disorders, substance use disorders, childhood psychiatric disorders, and depression.

EE seems to be a major factor in relapse and recurrence.  While EE affects the onset of these disorders and is high in families of children at risk of depression, it is not as robust a factor in the initial onset of these disorders as it is in relapse after remission.

High EE corresponds to a poorer prognosis.  The relapse rate for those living in a high EE environment is about 56%, 1.5 to 5x the rate for those in a low EE environment.

Professionals are high EE people.  Finally, professionals show a surprising degree of high EE.  We are sometimes a cause of relapse!  But with experience professionals learn to show lower EE and to be more successful with clients.

Three factors in high EE.   High EE does not mean all emotion, certainly not positive, supportive, encouraging, hopeful emotions.  But rather, high EE refers to three factors, Criticism, Hostility, and Over-involvement.

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Clinical News You Can Use: Anti-Depressants Less Effective in Mild and Moderate Depression

RESEARCH FINDINGS

A 2010 meta-anlysis* by Jay Fournier and Robert DeRubeis et al (JAMA, 303, January 6, 2010) showed that for mild-to-moderate depression, medication has little effect compared to placebo.  Most drug studies showing an impact for medications involve patients with more severe depressions.  Therefore, past studies have been more likely to show a strong effect.  This analysis shows that for the larger  mass of people with less severe depression, medication has little impact.  This finding has major implications for psychotherapists.

That psychotherapy alone can be highly effective with Reactive Depression, Adjustment Disorder with Depressed Mood, and mild-to-moderate Major Depressive Disorder is not surprising to seasoned therapists.  But the finding the medication alone is not effective in those cases is a new finding.

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