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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 40 to 64 of 105. Go back in thread:
Posted by Phillipa on September 18, 2006, at 19:21:47
In reply to Re: Emsam still working » Phillipa, posted by Jost on September 18, 2006, at 19:10:02
Thanks Jost not a lot of possitive responders left on EMSAM it seems wonder why? Love Phillipa
Posted by SLS on September 18, 2006, at 19:27:11
In reply to Re Fisher and Greenberg » SLS, posted by Jost on September 18, 2006, at 18:57:33
Hi Jost.
Thanks for posting that.
I think it helps to bring balance into the discussion.
However, it doesn't hide, in my mind, the lengths to which the authors (Fisher and Greenberg) go to pursuade people. I just hope that it becomes evident in their verbiage how desperate they are to plead their case.
- Scott
Posted by SLS on September 18, 2006, at 19:35:15
In reply to Re: Emsam still working » Jost, posted by Phillipa on September 18, 2006, at 19:21:47
> Thanks Jost not a lot of possitive responders left on EMSAM it seems wonder why? Love Phillipa
I think insomnia became an issue with some people and caused prompted them to discontinue it. I don't know how many weeks into treatment they were or what dosage they were taking. If you are going to get serious about trying an MAOI, you are going to have to also get serious about treating insomnia as a side effect and not allow it to be the thing that prevents you from getting well. You might need to add a sleeping medication to your Valium.
- Scott
Posted by jealibeanz on September 18, 2006, at 19:39:43
In reply to Re: Emsam still working » Phillipa, posted by SLS on September 18, 2006, at 19:35:15
Scott, remind me... do you have anxiety as well as depression? Is EMSAM the only med you're taking?
Posted by Phillipa on September 18, 2006, at 19:50:39
In reply to Re: Emsam still working » Phillipa, posted by SLS on September 18, 2006, at 19:35:15
Thanks Scott I know you're right. I'm so afraid of meds. Cause they killed my Mother when I was l7. That's why. Love Phillipa
Posted by SLS on September 18, 2006, at 20:27:20
In reply to Re: Emsam still working, posted by jealibeanz on September 18, 2006, at 19:39:43
> Scott, remind me... do you have anxiety as well as depression? Is EMSAM the only med you're taking?
Nope.
I'm not taking Emsam.
:-)
Currently:
Lamictal 150mg
nortriptyline 100mg
Topamax 100mg
Abilify 10mg
Lyrica 225mg
- Scott
Posted by Phillipa on September 18, 2006, at 20:56:18
In reply to Re: Emsam still working » Phillipa, posted by SLS on September 18, 2006, at 19:35:15
Scott what would go well with valium for sleep? Love Phillipa
Posted by jealibeanz on September 18, 2006, at 21:06:04
In reply to Re: Emsam still working, posted by SLS on September 18, 2006, at 20:27:20
Scott-
haha... my brains a little too full of schoolwork right now... must be imagining things!
Posted by cecilia on September 19, 2006, at 2:31:41
In reply to Re: Tonight I don't feel that antidepressants work » linkadge, posted by Racer on September 17, 2006, at 13:46:17
Well, if you define "respond" as having an effect, then the response rate is probably close to 100% (given a high enough dose). The trouble is, the responses I've had have never been exactly desirable!!!! What's a "response", what's a side effect? It depends what you're aiming for. Insomnia is a side effect if you have trouble sleeping, but a "response" if you can't stay awake. They use the "side-effect" of urinary retention for Cymbalta to market it for incontinence. Cecilia
Posted by SLS on September 19, 2006, at 4:06:18
In reply to Re: Tonight I don't feel that antidepressants work, posted by cecilia on September 19, 2006, at 2:31:41
> Well, if you define "respond" as having an effect, then the response rate is probably close to 100% (given a high enough dose). The trouble is, the responses I've had have never been exactly desirable!!!! What's a "response", what's a side effect? It depends what you're aiming for. Insomnia is a side effect if you have trouble sleeping, but a "response" if you can't stay awake. They use the "side-effect" of urinary retention for Cymbalta to market it for incontinence.
Yeah. I guess I've responded to a bunch of them - some of them only having numbers for names.
- Scott
Posted by linkadge on September 19, 2006, at 7:43:52
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 18, 2006, at 16:56:53
>I can see right through most of the arguments >presented in this article. I find them specious.
I see.
>I am familiar with them, and am also familiar >with the material that has proven them wrong
I wouldn't say that they are all proven wrong. That is kind of not possable.
>But I bet my stuff will stand the test of time.
Well at least thats a fair phrasing of your claim.
Linkadge
Posted by linkadge on September 19, 2006, at 7:47:14
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 18, 2006, at 18:56:09
[xxx] says it best.
"Faith in the integrity of biological psychiatry would be greater if the single strongest predictive factor in the outcome of any published clinical trial wasn't the identity of the funding body."
Linkadge
Posted by linkadge on September 19, 2006, at 7:51:47
In reply to Re Fisher and Greenberg » SLS, posted by Jost on September 18, 2006, at 18:57:33
I think its faily acurate to extend the findings of older drugs onto those of newer drugs. Many authors condend that newer AD's are really no more efficatious than older ones, although have an apparently more favorable side effect profile.
Drug companies fiercly oppose the use of active placebos in their clinical trials. This is because they know how hard it would be to prove their drugs usefull under such conditions.
Linkadge
Posted by SLS on September 19, 2006, at 7:53:17
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 19, 2006, at 7:47:14
> [xxx] says it best.
>
> "Faith in the integrity of biological psychiatry would be greater if the single strongest predictive factor in the outcome of any published clinical trial wasn't the identity of the funding body."
That is always the argument of last resort, isn't it?
- Scott
Posted by SLS on September 19, 2006, at 7:59:13
In reply to Re: Re Fisher and Greenberg, posted by linkadge on September 19, 2006, at 7:51:47
> Drug companies fiercly oppose the use of active placebos in their clinical trials. This is because they know how hard it would be to prove their drugs usefull under such conditions.
What leads believe this?
- Scot
Posted by linkadge on September 19, 2006, at 8:01:45
In reply to Re: Emsam still working » Jost, posted by Phillipa on September 18, 2006, at 19:21:47
My opinions are clearly not for those who are doing well on medications, but I am just trying to paint a realistic picture for those who don't.
But, personally, I am resistant to a lot of things. I remember in church wondering why I never had these "grand messages" from God, that all sorts of other people were having.
Linkadge
Posted by linkadge on September 19, 2006, at 8:04:38
In reply to Re: Emsam still working » SLS, posted by Phillipa on September 18, 2006, at 19:50:39
Well, they killed my mother 10 years ago. Even though she is still sitting on the couch.
Linkadge
Posted by linkadge on September 19, 2006, at 8:07:13
In reply to Re: Tonight I don't feel that antidepressants work » linkadge, posted by SLS on September 19, 2006, at 7:53:17
Hey, save the best for last!
Linkadge
Posted by linkadge on September 19, 2006, at 8:21:47
In reply to Re: Tonight I don't feel that antidepressants work » SLS, posted by linkadge on September 19, 2006, at 8:07:13
Some other interesting points:
The FDA requires at least two placebo-controlled trials with positive results to authorize a drug indication, regardless of how many trials fail to demonstrate the drug's superiority to placebo.
For example, the efficacy of Prozac could not be distinguished from placebo in 6 out of 10 clinical trials (Moore, 1999).
The "file-drawer problem" (i.e., the fact that negative results are less likely to be published than those with positive results; Rosenthal, 1979) renders it difficult to ascertain the meaningfulness of those studies actually showing differences.
In a controversial meta-analysis published in 1998, Irving Kirsch and Guy Sapirstein compared the mean effect size changes in symptoms of depression across 19 double-blind studies assessing the efficacy of antidepressant medications. Results demonstrated that placebos reproduced approximately 75% of the improvement found in the active drug. Furthermore, the authors assert that the remaining 25% of improvement accounted for by the active drug is debatable, and could be the result of an enhanced placebo response due to the side effects that patients experience when taking the active drugs, or other nonspecific factors.
But my favorite quote:"After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work. And so do sugar pills" (p. A01).
Linkadge
http://www.srmhp.org/0201/media-watch.html
Posted by linkadge on September 19, 2006, at 8:27:58
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 19, 2006, at 8:21:47
I'm not going to post anymore for this thread. I must stop myself because it is too time consuming and I have to do other work.
There is a significant amount of information in existence suggesting that antidepressant effectiveness is overhyped for a multitude of reasons. But really, just go to any search engine and type in "antidepressant + placebo", I'm sure there is enough information to keep people going for the next dacade.
The small difference between antidepressant and placebo has been referred to as a "dirty little secret" by clinical trial researchers (Hollon et al., 2002),
Linkadge
Posted by SLS on September 19, 2006, at 10:28:07
In reply to my last post for thread, posted by linkadge on September 19, 2006, at 8:27:58
> I'm not going to post anymore for this thread. I must stop myself because it is too time consuming and I have to do other work.
Yes, seeing so much in a printed page that you could just tear your hear out wanting to respond to is just too daunting to even contemplate composing a post to.
> There is a significant amount of information...or dysinformation, depending on your perspective.
> ...in existence suggesting that antidepressant effectiveness is overhyped for a multitude of reasons. But really, just go to any search engine and type in "antidepressant + placebo", I'm sure there is enough information to keep people going for the next dacade.
>
> The small difference between antidepressant and placebo has been referred to as a "dirty little secret" by clinical trial researchers (Hollon et al., 2002),It always sounds so persuasive when names are referred to when there is no literature to research and respond to.
I'm sorry for not giving you the last word, Linkadge. It almost doesn't seem fair. It does help, though, if you can supply the text along with a proper citation, or provide URLs to the literature being referred to. To refer to a name that alludes to a paper is not helpful. To refer to an article that refers to names and not citations to papers is not helpful.
I'm going to help you out, though.
I tried to track down your reference to "Moore, 1999" in a previous post. I couldn't find it, but I found something better. It was something he subsequently co-wrote.
www.alpha-stim.com/Information/Technology/Research/Research_PDF/EmperorsNewDrugs.pdf
Don't say I never did nuttin' for ya'.
;-)
- Scott
Posted by fca on September 19, 2006, at 11:18:47
In reply to Re: my last post for thread, posted by SLS on September 19, 2006, at 10:28:07
After following this discussion I felt compelled to scan the literature my self--I googled "efficacy SSRIs versus placebo". There were enough hits to keep me busy for several hours and I must have scanned the conclusion/summary of 25-30 scientific articles-- adults, elderly, children, meta-analyses all with placebo control, etc. I was hard pressed to find any where ADs did not show a superior 'response" and fewer "relapses" however they were defined. It ranged from 6% to 30+% statistically favorable profile of ADs over placebos and slightly stronger for relapses. Now I am sure some one can go out and collect a series of stdiues that show no or only minimal differences between ADs and placebos. I have chosen to put my money and well being in the hands of the ADs particularly based on information on relapse and long term follow up. PS I take ADs for primarily for an anxiety disorder and some relatively mild recurrent OCD.
I think one of the best and most objective summaries is the following:
http://www.srmhp.org/0201/media-watch.html
Here is the concluding paragraph
Therefore, contra some of the media "hype" on this topic, antidepressant research confirms an empirically demonstrated drug-placebo difference, although careful examination of this literature reveals that this difference is not nearly as large as most individuals believe, or as many of the pharmaceutical companies would have the public believe. Currently, the methodological problems with antidepressant trials preclude us from concluding definitively that the difference actually indicates specific biological effects of the drugs, as various nonspecific factors have not been adequately ruled out. Until these questions are answered, the media should understand that placebos can be double-edged swords, and that "expectancy" effects can result in harm as well as benefit. In a piece on this topic for the Guardian, a UK newspaper, Jerome Burne (2002) reports that many subjects in Leuchter's trial (2002) relapsed and requested to be placed on the active medication after learning they were in the placebo arm. Vedantam's Washington Post piece is similar to other articles on this topic that have appeared in the popular press recently, in that it occasionally betrays an imbalanced presentation of the evidence. The media should continue to follow this complicated debate and report on it responsibly, making certain not to overhype the "power" of placebo and, as a consequence, the "powerlessness" of antidepressants.
Posted by SLS on September 19, 2006, at 12:44:20
In reply to Here's my first and last word(s), posted by fca on September 19, 2006, at 11:18:47
> Therefore, contra some of the media "hype" on this topic, antidepressant research confirms an empirically demonstrated drug-placebo difference, although careful examination of this literature reveals that this difference is not nearly as large as most individuals believe, or as many of the pharmaceutical companies would have the public believe.
IMO: It is unfortunate that, in a rush to recruit patients for their studies, pharmaceutical-funded clinical trials have encouraged, perhaps unwittingly, the recruitment of people who are not suffering from true moderate to severe Major Depressive Disorder without a confounding comorbidity. This has both increased the rate of placebo response and reduced the rate of true drug response. My guess is that drug companies pay the clinical trial businesses by the subject and give incentives or apply pressure to expedite trial completion. This is probably more true now than it was 30 years ago. Thus we have seen a drift in both placebo and true drug response numbers in the directions I have indicated. This can be demonstrated in the literature.I think these drugs work better than many of the current clinical studies indicate, and at least as well as they did 30 years ago. Effexor might be the best antidepressant out there, and would probably give Anafranil a run for its money.
- Scott
Posted by SLS on September 19, 2006, at 12:47:47
In reply to Re: Here's my first and last word(s), posted by SLS on September 19, 2006, at 12:44:20
> > Therefore, contra some of the media "hype" on this topic, antidepressant research confirms an empirically demonstrated drug-placebo difference, although careful examination of this literature reveals that this difference is not nearly as large as most individuals believe, or as many of the pharmaceutical companies would have the public believe.
>
>
> IMO: It is unfortunate that, in a rush to recruit patients for their studies, pharmaceutical-funded clinical trials have encouraged, perhaps unwittingly, the recruitment of people who are not suffering from true moderate to severe Major Depressive Disorder without a confounding comorbidity. This has both increased the rate of placebo response and reduced the rate of true drug response. My guess is that drug companies pay the clinical trial businesses by the subject and give incentives or apply pressure to expedite trial completion. This is probably more true now than it was 30 years ago. Thus we have seen a drift in both placebo and true drug response numbers in the directions I have indicated. This can be demonstrated in the literature.
>
> I think these drugs work better than many of the current clinical studies indicate, and at least as well as they did 30 years ago. Effexor might be the best antidepressant out there, and would probably give Anafranil a run for its money.1. In terms of efficacy, not necessarily tolerability.
2. MAOIs aside.
- Scott
Posted by Racer on September 19, 2006, at 15:15:50
In reply to Re: Tonight I don't feel that antidepressants work » linkadge, posted by SLS on September 19, 2006, at 7:53:17
> > [xxx] says it best.
> >
> > "Faith in the integrity of biological psychiatry would be greater if the single strongest predictive factor in the outcome of any published clinical trial wasn't the identity of the funding body."
>
>
> That is always the argument of last resort, isn't it?Sure it is, Scott -- on accounta it stops the discussion flat doesn't it?
>
>
> - Scott
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