Psychotherapy vs. Pharmacotherapy

Thanks TulleKrazy. ==BOP== My opponent should lose the conduct vote for not answering my BOP until the last round and then changing her advocacy. I made clear starting in Round 2 that her BOP was to argue that drugs could not be used unless talk therapy was used first. Her new advocacy is unfair because it suddenly takes out a lot of my points, like stigma and speed of effect. Her new advocacy: + If a patient is diagnosed with MDD and is recommended Psychotherapy, and the patient does not want Psychotherapy, then prescribing drugs would be the SECOND RESPONSE + This is a silly interpretation of the topic. I can use this same twisted logic for my side. If BOTH talk therapy and drugs are recommended as the first response, and the patient says "no" to the drugs, the second response is then talk therapy. Pro accepts the BOP in this debate; since the world of Pro and the world of Con are now essentially the same – both involve 100% patient choice – you must vote Con on "presumption" (meaning: there is no net benefit to voting for either side, so Con wins by default, since Pro has the BOP). So either 1) you make her stick to her original advocacy, or 2) Con wins by default. If you as the judge are deciding which to choose, I urge the second :P ---MDD is caused by a chemical imbalance--- + compar[ing] MDD to Schizophrenia . . . is like apples to oranges + Talk therapy is also used to treat schizophrenia; it's just not as effective as drugs. [1] The same is true of MDD. My opponent provides no evidence on psychotherapy's effectiveness rate, while I've shown that 2/3 of patients are completely cured on the first anti-depressant prescribed and 80% on the second (University of Michigan evidence). + relapse rates are the same + This doesn't show effectiveness. Talk therapy could lead to a cure 10% of the time, and drugs could lead to a cure 66% of the time, but the relapse rate for both could be 30%. + The following link shows that Psychotherapy does have an effect on brain chemistry + "An effect" is not the same as curing the imbalance in norepinephrine, dopamine, and serotonin levels. Remember, the seminal study of endogenous depression was done by the British Medical Journal and found that 68% of depression had no external cause and was solely due to brain chemistry. My opponent says this study is old, but it is so well regarded, no new studies on endogenous depression have been needed. My opponent points out the study recommends Electro-shock therapy, but this treatment is still used today to treat the most severe cases of MDD (as my opponent herself suggests in her first Round). So, 68% of patients need only the chemical imbalance in their brains treated with drugs; they don't need talk therapy. This explains the popularity of anti-depressants in the U.S. ---Best treatment is BOTH--- My opponent points to her personal experience here, but my Laura Pinsky evidence references multiple studies and medical practitioners who all agree that patients get much more out of talk therapy if they are also on anti-depressants. Patients who fail to take anti-depressants often get too stressed out during therapy sessions when confronting sensitive issues in their lives and these topics must thus be avoided, severely impeding any progress. ---Speed of effect--- My opponent agrees that it takes 13 sessions and thus an average of three months for talk therapy to have an effect. Unfortunately, the average MDD patient only attends 9 talk therapy sessions. [2] For someone who is on the verge of suicide, a one-week solution is going to be far more effective than a solution that takes 3 months. Drugs are vital to preventing suicide. Remember my opponent's own study that anti-depressants eliminated suicidal thoughts in 74% of patients who had them. ---Miracle cures--- My opponent never answers my Psychology Today evidence or the UC Berkeley study that sleep disorders and MDD are often interlinked. Drugs are the only cure in this case. In addition, the experimental Yale ketamine study, proving a 100% cure rate with only one shot, is the wave of the future. Isn't an instant cure better than a 3 month, partially effective treatment? + placebo effect + The effect right after taking the first pill doesn't matter. In all the studies of FDA approved anti-depressants, the actual drugs have vastly outperformed the placebo. ---Stigma--- If you stick my opponent to her original advocacy, this is a clear win for me. 26% of patients would refuse talk therapy, meaning the first response for them should be drugs. Medical definitions of "first response" support my definition, that the treatment must actually be administered, not just proffered. [3] ---Quality of therapist--- My opponent questions my facts. According to the Bureau of Labor Statistics, psychologists only need a college degree (B.A.). [4] They are not exceedingly qualified medical practitioners. Psychiatrists, like any other doctor, need an M.D. to prescribe drugs. Thus my conclusion is valid: the people who prescribe drugs are far more qualified than the people who offer "talk therapy." ==Rebuttal to my opponent's case== My opponent doesn't really bother extending most of her arguments. Note: the numbering is from her original case (I) My opponent says diet and exercise can cure diabetes. Her source is from a question and answer site – it's not a study and doesn't show how many people this works for or what regimen of diet/exercise was followed. I don't recommend that the average diabetic stop taking his or her insulin injections, especially if the Diabetes is Type I, which would quickly result in death. (II) dropped by my opponent (III) Her link doesn't work, so I still can't see what percentage preferred each (was it 51% talk therapy vs. 49% drugs), and I can't tell if the group studied were all diagnosed with MDD (clinical depression) or just run-of-the-mill depression ("the blues"). In the beginning of her previous round, my opponent says the topic refers to *all* depression, but when she said in Round 1 "It would be nice if whoever takes this has a working knowledge of Major Depressive Disorder (MDD)," I assumed she meant "clinical depression," and she failed to clear this up in the previous round. Kind of unfair, again. But the main point here is if you stick my opponent to her original advocacy, patient choice wins the day, so this poll doesn't matter. If she goes with her second advocacy, there is no net benefit to voting for either side, so Con carries the day on presumption. (IV) Most debaters would consider later indicting your own study in bad form. (V) My opponent doesn't really extend her own argument here. (VI) Same (VII) The drugs cited by name in her source were NOT anti-depressants. She draws the link to anti-depressants outside the quotation marks. + Discontinued use + The Mayo Clinic says most anti-depressants are safe during pregnancy, and stopping anti-depressant use can affect a mother's food intake and energy levels, which can harm the baby. [5] Only the very oldest brands of anti-depressants have been linked to risk of heart disease. [6] I still don't understand why the average person who has his MDD well regulated on anti-depressants would suddenly choose to stop taking them. + Popularity + Doctors can't force patients to take anything. In fact, going to a psychiatrist to get drugs instead of a psychologist to get talk therapy is directly a patient's choice. If the patient doesn't want drugs but wants talk therapy, he or she should seek the services of a psychologist, who is legally barred from prescribing drugs due to the lack of an M.D. Thanks all. Vote Con. ==Citations== [1] http://tinyurl.com... [2] http://tinyurl.com... [3] http://tinyurl.com... [4] http://tinyurl.com... [5] http://tinyurl.com... [6] http://tinyurl.com...