Posted by SLS on July 15, 2006, at 7:15:39
In reply to Re: couldn't have said it better myself, posted by cecilia on July 15, 2006, at 6:46:39
> Well, something about the study still doesn't make sense. The drugs used were common, frequently used AD's and yet presumably people wouldn't be allowed into the study if they had already tried them without success.
I don't think we can make this presumption. Not at all.
> Where did they find these people with chronic treatment resistant depression who had never tried any of the most frequently used meds?
Again, you are acting on a presumption that is never applied in any other clinical study of antidepressants. Placing people on drugs that they have tried already occurs all of the time in controlled trials using comparators.
In any event, people were described in detail before entering the study which drugs were to be used. Again, this was described in the publications I cited. STAR*D was a monumentally important study. That it was provided only 35 million dollars is shameful.
> Still, it seems like this study did use a more varied population than most studies which have incredibly strict and specific criteria for inclusion.
It is my contention that the problem with clinical trials of antidepressants is precisely that the inclusion criteria are not rigid enough. Too many people with mild to moderate psychogenic depressions are allowed to participate. That is why the rate of placebo response is so high, and perhaps why the rate of response for the active compound is so low.
> When I had rTMS in Canada it sounded like virtually everyone there had gone there because they had been refused inclusion in the rTMS study in my home city.
They were deselecting for difficult cases that would reduce their response rate. This is very much different from what we are discussing here.
> I've never tried to get into a drug study, but I'm sure I'd be refused because I've tried so many meds, because I have anxiety as well as depression, because I have a number of medical problems with associated meds, and because my depression is chronic.
Again, if this were a clinical trial designed to get a drug approved for marketing, you would be deselected in order to insure a high success rate.
STAR*D had no such designs, and thus did not deselect difficult to treat cases. On the contrary, the nature of their recruitment process skewed the patient population towards these cases. This makes the positive results they obtained all the more encouraging.
- Scott
poster:SLS
thread:662854
URL: http://www.dr-bob.org/babble/20060709/msgs/667228.html