Posted by ed_uk on November 7, 2004, at 9:43:09
In reply to Re: Pregabalin (Lyrica) for Social Phobia, posted by jclint on November 7, 2004, at 8:58:24
Hi jclint,
I'm from West Yorkshire (Huddersfield) not Birmingham. Where do you live? At the moment I'm at the University in Manchester doing Pharmacy. Did you say you had social phobia? I don't remember. Which treatments for anxiety have you tried so far?Hi Scott,
If you look at many clinical studies which examine the efficacy of drugs in treating mental health problems, there are several recurrent themes which tend to emerge...a) The proportion of patients suffering from side effects is frequently high
b) The difference in efficacy between the active drug and placebo is often quite small (as measured by symptom rating scales).
c) Although the difference between the active drug and placebo is often statistically significant, it is very hard to demonstrate that it is clinically significant ie. drug generally provides slightly more symptom relief than placebo but at the expense of adverse effects, withdrawal symptoms and (often) unknown long term efficacy and safety.
d) studies which use an 'active' placebo often fail to show any statistically significant efficacy difference between the psychotropic and the active placebo.
Here is an interesting article....Active placebos versus antidepressants for depression.
Moncrieff J, Wessely S, Hardy R.
Psychiatry, University College London, Warley hospital, Mascalls Lane, Brentwood, Essex, UK, CM14 4TU.
BACKGROUND: Although there is a consensus that antidepressants are effective in depression, placebo effects are also thought to be substantial. Side effects of antidepressants may reveal the identity of medication to participants or investigators and thus may bias the results of conventional trials using inert placebos. Using an 'active' placebo which mimics some of the side effects of antidepressants may help to counteract this potential bias. OBJECTIVES: To investigate the efficacy of antidepressants when compared with 'active' placebos. SEARCH STRATEGY: The Cochrane Collaboration Depression, Anxiety and Neurosis review groups's search strategy was used to search MEDLINE (1966-2000), PsychLIT (1980-2000) and EMBASE (1974-2000) and this was last done in July 2000. Reference lists from relevant articles and textbooks were searched and 12 specialist journals were handsearched up to 1996. SELECTION CRITERIA: Randomised and quasi randomised controlled trials comparing antidepressants with active placebos in people with depression. DATA COLLECTION AND ANALYSIS: Since many different outcome measures were used a standard measure of effect was calculated for each trial. A subgroup analysis of inpatient and outpatient trials was conducted. Two reviewers independently assessed whether each trial met inclusion criteria. MAIN RESULTS: Nine studies involving 751 participants were included. Two of them produced effect sizes which showed a consistent and statistically significant difference in favour of the active drug. Combining all studies produced a pooled estimate of effect of 0.39 standard deviations (confidence interval, 0.24 to 0.54) in favour of the antidepressant measured by improvement in mood. There was high heterogeneity due to one strongly positive trial. Sensitivity analysis omitting this trial reduced the pooled effect to 0.17 (0.00 to 0.34). The pooled effect for inpatient and outpatient trials was highly sensitive to decisions about which combination of data was included but inpatient trials produced the lowest effects. REVIEWER'S CONCLUSIONS: The more conservative estimates from the present analysis found that differences between antidepressants and active placebos were small. This suggests that unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos. Further research into unblinding is warranted.
As you know all too well from personal experience, current psychiatric drugs often leave a lot to be desired!! Which ADs/or combinations of ADs have you not yet tried?
All the best...
Ed
poster:ed_uk
thread:412679
URL: http://www.dr-bob.org/babble/20041103/msgs/412842.html