Posted by ZyprexaNumbTongue on September 6, 2002, at 16:19:23
If you follow psychopharmacology, you will oftentimes read that antidepressants "are no better than placebo" or a sugar pill. This is constantly reitterated and hammered into our heads. Many believe it, unfortunately. However there are specific reasons why antidepressants sometimes perform no better than a sugar pill in clinical trials.
The main reason is that the subjects in these trials are carefully chosen by the people running these trials. Oftentimes the people chosen are not those with the severe forms of depression (melancholia subtype) who have real biological depression. Many times the people recruited for these studies are dysthymics...those with mild, chronic depression and moderate depression at worst. These sorts of depressives are depressed more because of their life situation or environment than any other reason. Furthermore their depression just isnt that bad to begin with compared with severe depressives.
Now you take a person with mild depression, who "thinks" they are oh so depressed, but in reality they have no earthly idea how bad things can get. Then you put them on an SSRI, another gets a sugar pill. The effect from the SSRI isnt going to be that dramatic usually, because the person really isnt that depressed to begin with. Furthermore the person might begin to experience a myriad of side effects such as sexual dysfunction and weight gain and this is a negative psychological experience for the dysthymic.
Thus its no wonder many clinical trials come back claiming SSRIs are no better than sugar pill placebos.
Additionally, quite a few of these "studies" designed to ascertain the effectiveness of antidepressants are run by psychologists, not by psychiatrists. Psychologists are more apt to believe in non drug therapies for even severe depression, so they are going to tend to bias there studies against drugs, while trying to make them look scientific and objective.
This is what we are up against if we have severe mental illness. Poor testing of new drugs. The test subjects typically are poor, the people doing the trials sometimes are not the best quality people in the world and have personal biases and beliefs which make it impossible for them to run good trials.
Instead, what should happen is ALL new antidepressants should be tested primarily on those with severe depressives, primarily of the melancholic subtype. Then we would begin to get more accurate assessments of the effectiveness of antidepressants. My guess were this to happen, we'd begin to hear less and less about antidepressants being no better than "sugar pills" and wed' begin reading that antidepressants are most helpful to those with severe depression...and least helpful to those with mild depression.
Oh yeah, another thought. I suppose all those nasty SSRI side effects like delayed ejaculation and weight gain are merely "placebo" side effects huh? They arent really there, they are only in your mind.
To summarize, psychologists should not be involved in running drug clinical trials. This job should be left strictly up to Medical Doctors and pharmacists. Secondly, new drugs should be primarily tested on severe, melancholic depressives and not on those with mild to moderate depression.
Then we wouldnt have to hear this crap about "placebo effect" anymore.
Zyprexa Numb Tongue.
poster:ZyprexaNumbTongue
thread:119067
URL: http://www.dr-bob.org/babble/20020906/msgs/119067.html