Psychotherapy vs. Pharmacotherapy

Thanks TulleKrazy. Extend the BOP. My opponent continues to argue in favor of robbing patients of their choice by forcing them to attend extensive talk therapy sessions before they can try drugs. I argue for no such restriction. + . . . + will denote an argument my opponent made ---MDD is caused by a chemical imbalance--- In Psychology 1 in college, you learn that mental illnesses have a genetic and environmental component. An environmental "trigger" turns on a certain combination of genes, which then permanently alter the person's brain chemistry. Let's say the "trigger" is a parent yelling really loudly at his child for 5 minutes straight. If the child is genetically pre-disposed to schizophrenia, the "trigger" will cause the child to develop schizophrenia. If the child is pre-disposed to MDD, the "trigger" will cause the child to develop MDD. Once MDD or schizophrenia is developed, the child will need medication to fix the brain chemistry imbalance or the mental illness will persist. Even if the child later receives counseling for the "severe yelling incident," the underlying brain chemistry alteration will not completely subside without medication. My opponent continues to refer to "depression" interchangeably with MDD ("clinical depression"). They are not the same. Depression can be overcome with solely talk therapy. My opponent has yet to provide evidence that talking to someone can cure serious imbalances in brain chemistry. My opponent claims that we can't know which came first, the chemical imbalance or the depression. However, according to the British Medical Journal, 68% of depression is endogenous, meaning a sudden onset with no external cause. [1] This means that the alteration in brain chemistry occurred first and caused the person to become depressed, without any external life problems that could have caused this sudden onset. ---Best treatment is BOTH--- My opponent claims that medicines are used to treat non-specific symptoms. This is actually the nature of diagnostic medicine. Anyone who has watched the show House knows that you cannot always be certain which targeted medication to choose. Doctors must sometimes test a few different medicines to see which will work best. However, the University of Michigan Medical School explains that two-thirds of doctors get the very first anti-depressant prescription 100% correct. [2] The success rate continues to go up as patients who don't react to the first anti-depressant try a second anti-depressant. My opponent should also tell you the very high failure rate of talk therapy, especially if a patient does not attend at least 13 sessions. Lastly, my opponent doesn't answer my evidence from Laura Pinsky of the Columbia University Psychology Center, which says that studies and interviews with therapists prove that without medicine, many patients are too broken down emotionally to confront the problems in their past and the current stresses in their lives. Anti-depressants help patients talk through issues they otherwise would break down discussing. Any patient who "tries" talk therapy for 13 straight sessions and sees it fail (because of the lack of drugs) will probably conclude that talk therapy doesn't work and never try it again. ---Miracle cures--- My opponent claims that suicidal patients might take too many sleeping pills, but these pills obviously wouldn't be prescribed to patients who are suicidal. By law, doctors cannot prescribe sleeping pills to someone who is showing suicidal tendencies. These pills can however help the many clinically depressed people who are not suicidal but suffer from serious problems in their sleep cycles. A recent study at UC Berkeley found that sleeping disorders can cause MDD and other mental illnesses. [3] Without allowing psychiatrists to prescribe drugs like 5-HTP, patients will make no progress in therapy because the underlying sleeping problems will not go away. My opponent's only response to the incredible ketamine study at Yale is: + Although the chemical imbalance in the brain may be remedied, alone, it doesn't change a person's thinking style, or propensity for negative cognitive disortions. + Actually, the balance of neurotransmitters in our brains directly affects our thought patterns. That's why hallucinogenic drugs have such an effect on our thoughts. ---Speed of effect--- My opponent doesn't contest that talk therapy takes at least 3 months to have any effect. Most suicidal people cannot wait this long; if you're suicidal, you don't even want to live until tomorrow. To someone who is suicidal, 3 months would seem like an unacceptable eternity if each day is such a burden that the person doesn't want to live anymore. Her link on Wellbutrin doesn't say anything about anti-depressants; also her facts are wrong – Wellbutrin acts on norephinephrine and dopamine, not serotonin. Either way, an immediate cure within two weeks is far more promising to someone who is suicidal than the hope of a slight improvement 3 months down the line. Extend my opponent's study that anti-depressants cure suicidal thoughts in 74% of patients. Lastly, if the suicidal person WANTS medicine, denying it to him for 3 months might prompt him to commit suicide in retaliation. The denial of medicine might be seen as the last straw in a cruel, cruel world. + placebo effect + The FDA won't approve a drug unless human studies prove that it is statistically significantly more effective than a placebo. The experimental group is typically given the drug; the control group is given a placebo. ---Stigma--- In an online poll, 26 percent of people said they would refuse to see a therapist either because of stigma or because "they wanted to solve their problems themselves." [4] If these people wanted medicine but not therapy, my opponent would deny them treatment. ---Quality of therapist--- Psychologists (talk therapists) often only have a college degree (often in sociology). You don't need a medical license to practice talk therapy. In contrast, psychiatrists are required to have a medical degree in order to prescribe drugs, but they often do not offer talk therapy services. The people who prescribe drugs are much more qualified than the people who do talk therapy. ==Rebuttal to my opponent's case== (I) My opponent doesn't like that people with illnesses need to keep taking medicine. If someone is diabetic, we should not expect him to be able to stop taking insulin injections. In the same way, if someone suffers from MDD, we should not expect him to be able to stop taking anti-depressants. (II) My opponent doesn't bother explaining her new source here. (III) My opponent cites a study (that it costs money to access) to prove that people prefer psychotherapy. The first page of the study, which is available, says anti-depressants are the most popular drug in North America. I ask her to provide the statistics on how many prefer each form of treatment. I also ask how many of these "depressed" people actually had MDD. And my opponent is the only one advocating we deny people a choice. (IV) This study is for my side now. (V) My opponent still provides no evidence that mania is a common side effect. In addition, misdiagnosis of MDD as bipolar disorder doesn't prove anti-depressants don't work. (VI) Don't deny the patient the choice. 68% of depression is endogenous depression, which is caused solely by chemical imbalance. (VII) Withdrawal. First, none of the drugs my opponent cites are anti-depressants (antipsychotics, benzodiazepines). Second, why would someone who had his or her depression cured on anti-depressants ever stop taking them? My opponent takes issue with anti-depressants being popular, but this is the result of patient choice. Let the people decide – vote Con. [1] http://tinyurl.com... [2] http://tinyurl.com... [3] http://tinyurl.com... [4] http://tinyurl.com...