Posted by SLS on May 11, 2009, at 15:11:05
In reply to Re: Antidepressants Hardly Help ?????????, posted by chumbawumba on May 11, 2009, at 14:22:31
> > This claim comes up every so often.
> >
> > It is untenable.
> >
> > The article is almost as flawed as the studies it cites. The selection procedure for subjects used in clinical trials of antidepressants almost never includes a diagnostic processing of each candidate thoroughly enough to conclude with certainty that the investigators are treating the right disease - major depressive disorder (MDD) or bipolar disorder (BD). That's why it is so often observed that the more severe depressions benefit the most. A much higher proportion of these subjects have the genuine diseases being investigated. Of course, this does not indicate that less severe cases of MDD or BD respond to treatment. It is just that severe cases are more likely to be the real thing when selection criteria are so liberally inclusive.
>
> Actually there was a different study you may have seen that addresses this issue and they found that when study inclusion criteria are narrow (like they are in Phase III clinical trials), the results seem to be skewed towards antidepressants. When they are broad so as to reflect more real life clinical practice conditions, efficacy drops.
>
> http://ajp.psychiatryonline.org/cgi/content/abstract/appi.ajp.2008.08071027v1
As much as I respect this syndicate of authors, two of whom I have seen personally, I must disagree with the premise of their argument.I have participated in phase III studies and have read the full articles of many more. I am convinced that it is not the selection criteria that are the problem, but, rather, the execution of the selection process. These authors ask us to assume that this process was executed properly in the studies they refer to. This is an assumption that cannot logically be made unless the authors can cite studies targeting this issue to prove it. There are very few studies of studies. I have never encountered a study of the execution and fidelity of selection procedures in phase III clinical trials of antidepressants. Selection is the most critical aspect of these studies, not the blinding of participants nor the presence of a placebo arm.
The authors of this article state:
"Phase III trials do not recruit representative treatment-seeking depressed patients"
This is absolutely true, and I am shocked that this study group is so unsophisticated as to forget to describe the many types of depressions that are part of this treatment-seeking population that they refer to. Who actually walks through the door? People can feel depressed for reasons ranging from the biological to the psychological to the situational for periods of time that are well over the two week minimum that is the criterion of the DSM IV. Someone with no biological depression can certainly be chronically depressed because of a multitude of psychological and emotional reasons. This is precisely the part of the population of treatment-seeking people who must be EXCLUDED rather than included. I contend that these subpopulations DO NOT suffer from having a biological illness that should be the target of these investigations.
- Scott
poster:SLS
thread:895119
URL: http://www.dr-bob.org/babble/20090505/msgs/895199.html