[Sanjay Gupta, Cnn:] Welcome to HOUSE CALL. We're making the rounds this morning to some of the most intriguing medical stories of the week. First up, it's the mainstay of saving those in cardiac arrest, but have we been doing it wrong? Then, they voted it number one. We're talking about the best treatments for depression. Also, what you need to know about new testing for allergies and how it could help you. Finally, could your birth order determine your success in life? Find out. Now, if you've ever taken a CPR course, you remember the drill. Breaths first, then chest compressions. But it turns out there may be a better way to save a life. Paramedics in Arizona have been doing something different and reporting they're that they're tripling the survival rate.
[Gupta:] Seven weeks ago, Mike Mertz collapsed at the wheel around the corner from his townhome in Glendale, Arizona.
[Mike Mertz, Cardiac Arrest Survivor:] And the fire department was here within about four or five minutes. And they performed on me here. That's how they got me stable enough to get to take me to the hospital.
[Gupta:] The paramedics saved Mertz with a new kind of CPR. The standard way, clear the airway, insert a breathing tube, then alternate two breaths with 30 chest compressions. But Glendale EMTs are doing it a new way. Start immediately with 200 chest compressions, strong and quick like this, 100 a minute. Then shock with an electrical defibrillator. Then another 200 compressions right away. No stopping to check for a pulse or another breath. Then Bobrow, who oversees the state's paramedics says it works because for the first several minutes after cardiac arrest, there's enough oxygen in the body to keep you alive for several minutes, but only if you pump on the chest to circulate blood. Any delay even to check a pulse or clear the airway, it's critical time that's lost.
[Ben Bobrow, Dr., Arizona Dept. Of Health Services:] Interrupting the blood flow to the heart and brain for even ten seconds can be all it takes to actually decrease the chance of a successful resuscitation.
[Gupta:] The American Heart Association says it needs to see more research before changing official CPR guidelines.
[Unidentified Male:] He truly was dead.
[Gupta:] Mike Mertz says the chance to meet the men who saved him is living proof the new way works. To be clear, this new technique is controversial. The American Heart Association says it doesn't plan to change it's guidelines for now. But either way, I strongly encourage every one of you at home to take a CPR class. I guarantee, you could possibly save a life one day. Now antidepressants are the most commonly prescribed drugs in the United States. So we recently reported that researchers in the United Kingdom found anti-depressants didn't work any better than placebos unless you're severely depressed. It's a finding that could have some people questioning the efficacy of these popular medications. On CNN.com this week, you voted to learn more about depression medications. So we invited Dr. Boadie Dunlop from Emory University School Medicine to join us. First of all, welcome to the show.
[Boadie Dunlop, Psychiatrist:] Thanks for inviting me.
[Gupta:] This was an interesting study. And I think, frankly, it scared a lot of people, saying maybe these medications weren't as effective as people thought. What do you think?
[Dunlop:] Yes, it did get a lot of attention around the world, sugar pill same as effective as an anti-depressant. The study that they did was a type of study where they grouped lots of trials together and look at the overall effect of the treatments. Those studies have been done before. And some of them have found anti-depressants to be better than placebos. Some have found no difference. The trouble with those kinds of studies is that they combine good studies with bad studies or I should say well designed studies with poorly less well designed studies. And so, you can dilute out true findings with less well defined studies. So this certainly isn't the last answer to this question.
[Gupta:] You know, it's interesting that you say this isn't the last answer. I mean, is there an answer? I mean, as a psychiatrist, can you say definitively that anti-depressants work?
[Dunlop:] I feel I can say that definitively, yes. And the difficulty is that when you do studies for a short periods, you do induce a lot of placebo response. Where you can see anti-depressants separate from placebo is over the longer period. That's where you can really see the benefit of anti-depressants, preventing relapse of depression.
[Gupta:] So you're saying, you know, if someone were to take a sugar pill or an antidepressant in the short-term, there may not be a huge difference. But longer term, the placebo or sugar pill is not going to last.
[Dunlop:] Yes. And it varies by individual. Some people will not respond to placebo at all and some people do. And it's a very interesting question about what those factors are.
[Gupta:] You know, everyone talks about the fact that we over- prescribe anti-depressants. I think every time we've talked about this topic, someone has written in and said that. What of it? Do we over-prescribe these medications? How do you know when you really need the medication?
[Dunlop:] Well, that's a difficult decision, because it's not just the doctor's decision. The patient has to be willing to go along with what the doctor's recommending. The doctor may say, you know, psychotherapy would be the best option for you, talk therapy. But if the patient doesn't want to do it, what are you going to do? They're still suffering, they still want help. What we know that is in mild depression, people on average do better with talk therapy than they do with medication. That's the average person. Now some people may need medicine in a mild depression. But in severe depression, people clearly need medication to get better nearly always, often in combination with psychotherapy.
[Gupta:] There's so many antidepressants out there. If someone has severe depression, as a psychiatrist, how do you know which medication you're going to start with or which ones work best?
[Dunlop:] Well, that's a real challenge. There is no indication that any one antidepressant is better than than any other. However, what we do know is that people have depression and anxiety combined, that serotonin drugs seem to be better treatments. So an SSRI like Sertalene, which is Zoloft, or Fluxtene, which is Prozac would be a better option than Vieproprion, which is Wellbutrine in someone with mixed anxiety and depression.
[Gupta:] Is there an option to try talk therapy always first? I mean do you say, look, let's always leave medication as a sort of a second resort. Let's try other things first. Or how quick are you to pull out the prescription pad?
[Dunlop:] Well, it's a very challenging decision. And it really is something you work out with the patient. It matters with the level of distress they have, the level of thoughts of self harm they have. So generally, though, the greater the severity, the more I am likely to indicate we need to use anti-depressants from the beginning. And sometimes, that helps the talk therapy go better.
[Gupta:] Not the last word, what do we need to do to get to that final word?
[Dunlop:] Well, we need more research into the biology of placebo response, better design of clinical trials. And there are efforts underway at Emory and elsewhere to achieve that.
[Gupta:] All right. Well, we will have you back to talk about, because we would like the final word one day hopefully on anti- depressants. Dr. Boadie Dunlop, thank you so much. Now since the 1920s, 57 percent of presidents have been first- born children. Think about that. So does your birth order determine your success in life? And pollen season, it's right around the corner. That's the bad news. The good news, your doctor may be better able to better diagnose your allergies. We'll tell you why. Plus, what's in your drinking water? Probably not what you expect. Find out what's coming out of your tap. That's right after the break.