Posted by Larry Hoover on April 19, 2008, at 16:44:39
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 10:30:17
> Anyhow, the point is with these drugs, is that it doesn't matter how much you talk to people about their lack of established efficacy, you are still going to get people who refuse to look at good science like this.
Well, the question of good science is one not clearly ascribed to him, but Kirsch found that antidepressants were more effective than placebo, p <.001. Kirsch himself established efficacy.
Moreover, when presented with scientific arguments as to why e.g. failed studies are not meaningful, you dismiss the argument outright. What part of scientific analysis suits you? What part of the limitations of post hoc analysis will you accept? Only those bits that fit in with your own beliefs, apparently.
> Then you get those babblers who are resorting to the very devices they condemn. The very babblers that suggest that single case reports are weak seem return to the logic that "they work for me, and that's all that matters".
Same goes for those who claim they didn't work. Unfortunately, the plural of anecdote is not data. That's why I rely on the science.
> As mentioned it includes data that the drug companies conveniently left out which increases its validity beyond any one single study or any previous subgroup of *more positive* released trial data.
The same dataset has been studied and analyzed ad nauseum. There is no new finding in Kirsch's analysis, but for the post hoc application of a new and arbitrary standard of clinical significance. However, to limit the data used for such an analysis to this small grouping of ancient papers suits his purpose, as he already new what he'd "discover". That is intellectually dishonest. Period.
> Even those of you who publicly dismiss this study are probably saying to themselves "man, this really sucks".
No, I'm saying this Kirsch paper really sucks. It is meaningless, but for its propaganda value. NICE did a far better job of it, and before he published.
> The clinical trial is unfortunately the only real way to scientifically establish the efficacy of antidepressants.
Antidepressants superior to placebo, p <.001.
> Other forms of persuasion are not scientific and therefore don't mean a whole lot.
Then, I guess we're finished. p <.001.
> When people make certain faulty conclusions, it tends to stick even in the face of contradictory information.
Why is it that this thread only includes accusations of belief perseverence and faulty conclusions, when applied to those who don't accept that placebos are as efficacious as antidepressants?
> Another thing to consider is this: Most people are here because their antidepressant is not working the way they would like it to. That's why I take their proclamations with a grain of salt. Many of the people here arguing may just be doing so to re-establish their faith in the drugs. It's like...it seems like you're more trying to convince yourself. Its just like my brother at Bible college. Even he admits that arguing for Christianity bolsters his faith when even he is doubting it. After all, arguing a particular point of view is the first step to believing it.
That argument doesn't apply to me.
> The idea that it is hard to distinguish antidepressants from placebos is not new and has long preceded this study.And has always failed when put to critical thinking tests. Only people like Kirsch, who can ignore his own antidepressants significantly better than placebo result, one chance in 1000 (or less) that it is not a "real difference", support the equivalence theory. I asked people to look at Kirsch's graphs, and it is just as obvious in a pictorial form. The two are non-equivalent, and you can see that clearly.
> What always surprises me though is that if this kind of meta analysis occurred for a cholesteral lowering drug ie. you found out that you were taking a certain cholesterol lowering drug that was generally no better than placebo, most people would note get all defensive.Cholesterol is measured in different ways than is depression. Notwithstanding that limitation, antidepressants are significantly better than placebo, p <.001.
> Probably because there isn't the same kind of surge in introspection upon initiation of a cholesterol drug.
No. Probably because mental illness is inferential.
> The argument for endogenous depression is a valid one. But, provide me any data anywhere that the current line of antidepressants addresses any one proven chemical imbalance. For instance, the majority of the findings suggest that SERT activity is in fact low in depression. You're not targeting any imbalance by giving SERT inhibitors to these individuals. Other studyies suggest that NET is low and even MAO is decreased.
Depression is a symptom, not a disease of one etiology. Let us postulate that depression has three distinct causes. If we were unable to distinguish the three forms, and treated all of them as if they were homogenous, would it be a surprise to discover that response was limited? If equally prevalent, a given mode of treatment would at most reach 33% of the subjects. That hypothetical is nothing more than my attempt to illustrate that a failure to discriminate etiologies of depression must limit efficacies of treatment(s). Nobody ever argued that drugs work for all depressives, but the clear evidence is that they robustly work for some of them. And, as the combination of e.g. psychotherapy and antidepressant works better than either one alone, that convincingly shows (IMHO) that there is more to antidepressant response than simply obtaining placebo response.....otherwise, therapy plus antidepressant would be the same as therapy alone.
> People can, and often do feel better off drugs.
Plural of anecdote not data, again.
> This is in no way a sign that their depression is not due to some biochemical abnormality. Like mentioned above, it would seem reasonable to me that an individual with an already abnormally low level of the serotonin transporter takes a drug that lowers it further, they may just feel worse. I know severely depressed individuals who simply feel worse on drugs period. Psychiatry does not have all the tools and all the answers.
Of course not. But the answer is found by doing the experiments required.
> If anything I would hope that some of the current studies could help liberate certain individuals. You see people on this board who have never (or rarely) helped by an antidepressant, yet they somehow feel that the drugs work and there is something wrong with them when they don't. I would hope that data like this would be liberating. I.e. perhaps by seeing that they don't work for others too, they might stop beating themselves up about the issue and go look for answers somewhere else.
Further experimentation is indeed the answer. Including different drugs, also, IMHO. No point limiting treatment opportunities based on thought experiments.
> So, I digress. The establishment of a solid logical arugument does not depend on the ability to convince of any one individual. The more I am away from babble the more I realize how much "GroupThink" goes on here.I'm not one of those. Just for the record.
> One person talks about a drug then all of a sudden another person needs it. Also, the more time you spend on a board discussing drugs, the more you don't see the other ways that you can address your problems. Petting a dog will raise your serotonin you know.
Assuming that serotonin levels are the issue. You argued alternative mechanisms, earlier. ;-)Whatever works, works.
> Its just like some of the issues brought up by Bulldog. Many people are just at their wits end in terms of who to believe about who has the answers for their problems. Believing that prescription antidepressants are the only ways to solve your problems is seductively convenient.
Dismissing them outright is dangerous, IMHO. Look at what happened to child suicide rates as a result of the warnings. Better management is the answer, not drug avoidance.
> It allows you to narrow your focus and disregard other useful information. It makes life easy, or does it?
I'm not sure you're being fair to your readers.
> If the drugs work for you, then great: live happily ever after. For the rest of us, don't be so surprised and upset when you're not getting prozac.com type results.
Not sure what your point is here.
> Trust yourselves for a change, and reflect critically upon data like this. It may be more liberating than you know.
That's all I've been doing, reflecting critically. And Kirsch has not met his burden.
> Anyhow, I just thought I'd stop by and say hi.Hi, link. Sorry I didn't greet you earlier. I was caught up in debate. You are missed.
> To somebody who was on lithium, zoloft, depakote, zyprexa, clonazepam and ritalin, (all at once) and told by top psychiatrists that I will never be able to live medication free, diet, exercise, and certain supplements have gone a long way.There are many many positive lifestyle changes that can impact symptoms and vulnerabilities. I'm glad you've found some relief.
> Obviously not all cases are like this, but the point I am trying to make is to never stop rethinking and reasessing exactly what the meds are and are not doing for you.
>
> LinkadgeBest to you, link.
Lar
poster:Larry Hoover
thread:823248
URL: http://www.dr-bob.org/babble/20080412/msgs/824312.html