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Re: Tonight I don't feel that antidepressants work

Posted by SLS on September 17, 2006, at 10:18:09

In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 17, 2006, at 9:01:57

> I think that the number of people who are actually helped by the medications is overstated.
>
> Some of the latest trials show that only something like %30 of people get any help, and more get help with placebo.


I'll be the optimist.

In clinical trials: With any single antidepressant, 65-70% improve with greater than a 50% reduction in rating scale scores. 35-40% achieve remission at 6 weeks. Again, this represents the likelihood that someone will respond to that specific antidepressant if tried.

Now, the thing is, these trials stop at 6 weeks. What if the 50% reduction responders were evaluated at 6 months? How many of them would go on to full remission? Hmm.

Placebo comes in at 25-30% Even though placebo usually comes in with statistically lower numbers than antidepressants, the rate is, in my opinion, too high for reasons that I have discussed along other threads. They involve selection criteria and the allowance of subjects who I do not believe meet the criteria for a properly diagnosed Major Depressive Disorder (MDD). Now. The thing is, these studies stop at 6 weeks. Placebo pattern responders, as identified by Quitkin et al., have been shown to relapse more frequently than true drug responders. They, too, are not followed beyond 6 weeks.

Remission rates with SNRI, SSRI, placebo: pooled analysis of major studies:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11230034&query_hl=3&itool=pubmed_DocSum

Br J Psychiatry. 2001 Mar;178:234-41. Related Articles, Links
Click here to read
Comment in:

* Br J Psychiatry. 2001 Jul;179:79.
* Br J Psychiatry. 2002 Jan;180:82-3.
* Br J Psychiatry. 2004 May;184:452-3.


Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors.

Thase ME, Entsuah AR, Rudolph RL.

University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213-2593, USA.

BACKGROUND: It had been suggested that the antidepressant venlafaxine, which inhibits reuptake of both serotonin and (at higher doses) noradrenaline, may result in better outcomes than treatment with selective serotonin reuptake inhibitors (SSRIs). AIMS: To compare remission rates during treatment with SSRIs or venlafaxine. METHOD: Data from eight comparable randomised, double-blind studies of major depressive disorder were pooled to compare remission rates (Hamilton Rating Scale for Depression score < or = 7) during treatment with venlafaxine (n = 851), SSRIs (fluoxetine, paroxetine, fluvoxamine; n = 748) or placebo (four studies; n = 446). RESULTS: Remission rates were: venlafaxine, 45% (382/851); SSRIs, 35% (260/748); placebo, 25% (110/446) (P: < 0.001; odds ratio for remission is 1.50 (1.3-1.9), favouring venlafaxine v. SSRIs). The difference between venlafaxine and the SSRIs was significant at week 2, whereas the difference between SSRIs and placebo reached significance at week 4. Results were not dependent on any one study or the definition of remission. CONCLUSIONS: Remission rates were significantly higher with venlafaxine than with an SSRI.

Publication Types:

* Meta-Analysis


PMID: 11230034 [PubMed - indexed for MEDLINE]


- Scott

 

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