Posted by doxogenic boy on November 6, 2013, at 17:57:31
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by larryhoover on November 4, 2013, at 22:55:52
> > Do you know of more articles (from psychologist or psychiatrists) with critical analyses of Kirsch's claims about antidepressants? My interest into this is because of a general interest in psychiatry and because I use psychotropic drugs myself.
> >
> > - doxogenic
>
> You'll also find links to some very cogent critical reviews of Kirsch referenced within this article.
>
> http://blogs.plos.org/mindthebrain/2012/12/26/the-antidepressant-wars-a-sequel-how-the-media-distort-findings-and-do-harm-to-patients/
>
> Here's a much more useful analysis of similar data reported upon by Kirsch:
> http://www.nice.org.uk/nicemedia/pdf/cg023fullguideline.pdf
>
> A re-analysis of Kirsch's data, showing he misreported his results:
> http://www.ncbi.nlm.nih.gov/pubmed/20800012
Thank you very much, this was new information for me. I have found some more:http://www.ncbi.nlm.nih.gov/pubmed/19588448
Quote from the link above:
Cochrane Database Syst Rev. 2009 Jul 8;(3):CD007954. doi: 10.1002/14651858.CD007954.
Antidepressants versus placebo for depression in primary care.
Arroll B, Elley CR, Fishman T, Goodyear-Smith FA, Kenealy T, Blashki G, Kerse N, Macgillivray S.
SourceDepartment of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Abstract
BACKGROUND:Concern has been expressed about the relevance of secondary care studies to primary care patients specifically about the effectiveness of antidepressant medication. There is a need to review the evidence of only those studies that have been conducted comparing antidepressant efficacy with placebo in primary care-based samples.
OBJECTIVES:To determine the efficacy and tolerability of antidepressants in patients (under the age of 65 years) with depression in primary care.
SEARCH STRATEGY:All searches were conducted in September 2007.The Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Controlled Trials Register was searched, together with a supplementary search of MEDLINE, PsycINFO, EMBASE, LILACS, CINAHL and PSYNDEX. Abstracts of all possible studies for inclusion were assessed independently by two reviewers. Further trials were sought through searching the reference lists of studies initially identified and by scrutinising other relevant review papers. Selected authors and experts were also contacted.
SELECTION CRITERIA:Studies were selected if they were randomised controlled trials of tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) versus placebo in adults. Older patients (over 65 years) were excluded. Patients had to be recruited from a primary care setting. For continuous outcomes the Hamilton Depression scale of the Montgomery Asberg Scale was requred.
DATA COLLECTION AND ANALYSIS:Data were extracted using data extraction forms by two reviewers independently, with disagreements resolved by discussion. A similar process was used for the validity assessment. Pooling of results was done using Review Manager 5. The primary outcome was depression reduction, based on a dichotomous measure of clinical response, using relative risk (RR), and on a continuous measure of depression symptoms, using the mean difference (MD), with 95% confidence intervals (CI).
MAIN RESULTS:There were fourteen studies (16 comparisons) with extractable data included in the review, of which ten studies examined TCAs, two examined SSRIs and two included both classes, all compared with placebo. The number of participants in the intervention groups was 1364 and in the placebo groups 919. Nearly all studies were of short duration, typically 6-8 weeks. Pooled estimates of efficacy data showed an RR of 1.24, 95% CI 1.11-1.38 in favour of TCAs against placebo. For SSRIs this was 1.28, 95% CI 1.15 to 1.43.. The numbers needed to treat (NNT) for TCAs ranged from 7 to 16 {median NNT 9} patient expected event rate ranged from 63% to 26% respectively) and for SSRIs from 7 to 8 {median NNT 7} (patient expected event rate ranged from 48% to 42% respectively) . The numbers needed to harm (NNH for withdrawal due to side effects) ranged from 4 to 30 for TCAs (excluding three studies with no harmful events leading to withdrawal) and 20 to 90 for SSRIs.
AUTHORS' CONCLUSIONS:Both TCAs and SSRIs are effective for depression treated in primary care.
End quote.
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http://www.ncbi.nlm.nih.gov/pubmed/22033583Quote from the link above:
Eur Arch Psychiatry Clin Neurosci. 2011 Nov;261 Suppl 3:207-45. doi: 10.1007/s00406-011-0259-6.
General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA section of pharmacopsychiatry.
Baghai TC, Blier P, Baldwin DS, Bauer M, Goodwin GM, Fountoulakis KN, Kasper S, Leonard BE, Malt UF, Stein D, Versiani M, Möller HJ; Section of Pharmacopsychiatry, World Psychiatric Association.
Collaborators (46)
SourceDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian-University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany. Thomas.Baghai@medbo.de
AbstractCurrent gold standard approaches to the treatment of depression include pharmacotherapeutic and psychotherapeutic interventions with social support. Due to current controversies concerning the efficacy of antidepressants in randomized controlled trials, the generalizability of study findings to wider clinical practice and the increasing importance of socioeconomic considerations, it seems timely to address the uncertainty of concerned patients and relatives, and their treating psychiatrists and general practitioners. We therefore discuss both the efficacy and clinical effectiveness of antidepressants in the treatment of depressive disorders. We explain and clarify useful measures for assessing clinically meaningful antidepressant treatment effects and the types of studies that are useful for addressing uncertainties. This includes considerations of methodological issues in randomized controlled studies, meta-analyses, and effectiveness studies. Furthermore, we summarize the differential efficacy and effectiveness of antidepressants with distinct pharmacodynamic properties, and differences between studies using antidepressants and/or psychotherapy. We also address the differential effectiveness of antidepressant drugs with differing modes of action and in varying subtypes of depressive disorder. After highlighting the clinical usefulness of treatment algorithms and the divergent biological, psychological, and clinical efforts to predict the effectiveness of antidepressant treatments, we conclude that the spectrum of different antidepressant treatments has broadened over the last few decades. The efficacy and clinical effectiveness of antidepressants is statistically significant, clinically relevant, and proven repeatedly. Further optimization of treatment can be helped by clearly structured treatment algorithms and the implementation of psychotherapeutic interventions. Modern individualized antidepressant treatment is in most cases a well-tolerated and efficacious approach to minimize the negative impact of otherwise potentially devastating and life-threatening outcomes in depressive disorders.
End quote.
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http://www.ncbi.nlm.nih.gov/pubmed/23552610
Quote from the link above:Psychol Med. 2013 Apr 3:1-11. [Epub ahead of print]
Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis.
Cuijpers P, Turner EH, Mohr DC, Hofmann SG, Andersson G, Berking M, Coyne J.
SourceDepartment of Clinical Psychology, VU University Amsterdam, The Netherlands.
Abstract
BACKGROUND:The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo. Method Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges' g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses.
RESULTS:The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14-0.36, I 2 = 0%, 95% CI 0-58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00-12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size.
CONCLUSIONS:Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.
End quote.- doxogenic
Earlier TRD/anxiety
300 mg tianeptine, 6 X 50 mg successfully since Oct 2009
20 mcg liothyronine
40 mg escitalopram
100 mg trimipramine
50 mg agomelatine
600 mg quetiapine
poster:doxogenic boy
thread:1052457
URL: http://www.dr-bob.org/babble/20131025/msgs/1053904.html