Posted by viridis on February 9, 2003, at 18:10:39
In reply to Re: Anti_depressants little more than placebos? » Larry Hoover, posted by mattdds on February 9, 2003, at 17:41:30
Part of the problem in interpreting the results, too, is that even if a substantial fraction of the treatment group really do improve, you could have a situation in which some other fraction actually get worse, so the net effect is an average change in depression rating that isn't much better than placebo.
Most of us have first-hand experience with the great variation among individuals in drug response. Especially with psychiatric meds, what helps one person may be negative, not just neutral, in another. For example, most SSRIs don't appear to fare too well in placebo-controlled trials. My experience with those I've tried has been very negative, so if I were in the treatment group I'd probably report a worsening of symptoms. Yet, I can't deny that these are great drugs for some people, based on the sometimes-dramatic improvements I've seen in friends who have taken Prozac, Celexa, Paxil, etc.
I guess the real key will be development of tests that more accurately identify the likely cause of an individual's depression. This would allow design of placebo-controlled trials for specific meds targeted to those with markers for particular subtypes of depression (e.g., those associated with reduced serotonin availability vs. those tied more to norepinephrine, etc.). I suspect that if such an approach were feasible, the results in favor of particular ADs would be more impressive.
We're not there yet, but I expect that in the next 5-10 years it will actually be possible to screen for genetic markers associated with specific types of depression (and other mental illnesses). This will allow a much more targeted approach to treatment, instead of the tedious and painful trial-and-error approach that's often necessary now. I have my fingers crossed...
poster:viridis
thread:140316
URL: http://www.dr-bob.org/babble/20030208/msgs/140340.html