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Dr. Bob is Robert Hsiung, MD,
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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
Posted by SLS on September 19, 2006, at 15:47:03
In reply to Re: Tonight I don't feel that antidepressants work » SLS, posted by Racer on September 19, 2006, at 15:15:50
> > > [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?
Democracy and capitalism.They're the worst!
- Scott
Posted by fca on September 19, 2006, at 16:15:20
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 19, 2006, at 15:47:03
yes, with out them--demcracy and capitalism--we would still be using thorazine, phenobarbitol and alcohol. With the exception of a timy bit from China nothing worthwhile has come out of totalitarian or nondemocratic countries for ages, if ever. I suppose if I looked I could find something--lets face it. The US, Europe (particularly England, France Switzerland and Germany) have dominated drug development and discovery. I am not sure why I am writing this but I was working in MH before the development of atypicals, SSRIs and the new generation of mood stabilizers, anxyolitics and ADD agents. It was not a pretty picture. I worked in a MH hospital that had over 4,000 patients and now has 160. Maybe it should have a few more but a lot of us would be living in shared dormitories with 30-60 other people if it was not for the advances in medication. I do not mean just those with psychosis. The hospitals were full of people with severe anxiety disorders, depression and ADHD--many there because their brains had been fried on barbituates, alcohol and the early antipsychotics or almost complete isolation from family and friends. We are no where near the end of our search but we are a lot further than those struggling with cancer and many other chronic illnesses. Thanks FCA
Posted by johnnyj on September 19, 2006, at 16:58:40
In reply to They are working much better than we think--, posted by fca on September 19, 2006, at 16:15:20
May I ask what you take? I have anxiety that manifests itself in ocd too. I was curious if you find an ssri helpful? Do you take a benzo too?
Posted by fca on September 19, 2006, at 17:37:30
In reply to They are working much better than we think--, posted by fca on September 19, 2006, at 16:15:20
Sure, I take Paxil 40 and klonopin PRN. When my most recent relapse occured 5 months ago(6 months after discontinuing meds) I started on lexapro 20 and klonopin. My pdoc became frustrated with my unwillingness to aggressively manage the acute anxiety with Klonopin and insisted I take it (.5 to 1.5)daily. The acute anxiety resolved fairly quickly under her direction and I switched to Paxil which kicked in about 3 weeks after initiation. The lexapro did not work very well even though I had been responsive to it previously. There is no doubt that Paxil is working much better for me than Lexapro ever did. I now take .125 to .25 klonopin 4-5 times a week and do not appear to have developed any tolerance over a 5 month period. FWIW and strictly anecdotally and unscientifically I think the earlier and dirtier SSRIs work better for OCD than the newer ones. BTW, I am feeling quite good and almost all my symptoms are gone--I also immersed myself in ERP this time ( with a very skilled therapist) which I had not done before--a little CBT years ago. Hope this helps fca
Posted by Racer on September 19, 2006, at 17:45:33
In reply to They are working much better than we think--, posted by fca on September 19, 2006, at 16:15:20
> yes, with out them--demcracy and capitalism--we would still be using thorazine, phenobarbitol and alcohol. I am not sure why I am writing this but I was working in MH before the development of atypicals, SSRIs and the new generation of mood stabilizers, anxyolitics and ADD agents. It was not a pretty picture. I worked in a MH hospital that had over 4,000 patients and now has 160. Maybe it should have a few more but a lot of us would be living in shared dormitories with 30-60 other people if it was not for the advances in medication. I do not mean just those with psychosis. The hospitals were full of people with severe anxiety disorders, depression and ADHD--many there because their brains had been fried on barbituates, alcohol and the early antipsychotics or almost complete isolation from family and friends. We are no where near the end of our search but we are a lot further than those struggling with cancer and many other chronic illnesses. Thanks FCA
I gotta agree with this. My first hospitalization, I remember when meds were given in the afternoon. This was the peds ward, and the normally active kids were suddenly staggering around like zombies. Obviously, not everyone was medicated, but those that were -- well, I'm just glad that doesn't happen as much anymore. (Although I'm told it's still the case in juvie jail...)
And what is "ERP?" How does it work? (I'm always interested in learning more -- especially if it could help me...)
Posted by fca on September 19, 2006, at 18:57:50
In reply to One comment, one question... » fca, posted by Racer on September 19, 2006, at 17:45:33
form of CBT used specifically for OCD. It stands for Exposure Response Prevention which involves using imaginal scripts,or real life experiences, to systematically immerse your self in your worst and most irrational fears. It is much like the systematic desensitization used for phobias--successive approximation to the feared object. However, with OCD the fears (obsessions)are cognitive and the compulsions are behavioral. With the obsessionsal thoughts one uses very specific written scripts that "force" you to confront (imagine)your worst fears (losing ones mind, being gay, getting contaminated) by imaging those events in excruciating detail. It took the therapist and I two hours to construct my first 20 minute script. For two months I read, wrote(typed) and listened to the recorded script for 20 minutes(each) or a total of one hour daily.I am now doing five minutes each activity every other day. Snce I have "pure OCD" there were no specific behavioral compulsions I needed to work through. The classic example of working through a compulsive avoidance behavior is moving a person with irrational contamination fears from not using public restrooms to eventually placing their hands in a flushed toilet. One of the most esteemed CBT/ERP therapists in the country will lick the bottom of his shoe during the first session of persons presenting with contamination fears. Not to embarrass or humiliate them but to demonstrate what they will be doing before the termination of treatment. It is a challenging, rewardimg, demanding and intellectually stimulating form of treatment for both the therapist and patient. And, repeated studies demonstrate its efficacy. The sole purpose of all these activites is to remove the affective component of the thoughts and behaviors so they become "just thoughts" not special or fearful thoughts. Do it until you are bored silly as it is the irrational fear that perpetuates the thoughts,
Sorry for going on. fca
Posted by Phillipa on September 19, 2006, at 20:36:41
In reply to Tonight I don't feel that antidepressants work, posted by Phillipa on September 16, 2006, at 23:23:47
So do we have a final conclusion? Mine is that therphy has as great an impact as meds for many people. And you can't just sit home have to get out no matter how painful. And I still believe that benzos are the meds for anxiety. They work, they are safe, and you don't increase doses as when you feel better it's just a normal thing to me to use less. Love Phillipa
Posted by SLS on September 19, 2006, at 21:25:06
In reply to Re: Tonight I don't feel that antidepressants work, posted by Phillipa on September 19, 2006, at 20:36:41
> So do we have a final conclusion?
I didn't know it was up for a vote.
> Mine is that therphy has as great an impact as meds for many people. And you can't just sit home have to get out no matter how painful.
That doesn't sound like any kind of life I want to lead. I hope there is better for me out there.
> And I still believe that benzos are the meds for anxiety.
I'm sure there are doctors who continue to resist the idea that SRIs and MAOIs have a place in the treatment of anxiety disorders.
> They work, they are safe, and you don't increase doses as when you feel better it's just a normal thing to me to use less.
What is it about your treatment that you continue to find inadequate?
- Scott
Posted by Phillipa on September 19, 2006, at 21:51:33
In reply to Re: Tonight I don't feel that antidepressants work » Phillipa, posted by SLS on September 19, 2006, at 21:25:06
The ad's don't work for me and to me it seems if your brain wanted them or they were good for you you wouldn't have side effects. I force myself out of bed daily. And my pdoc says what do you want to try now. I'm the one paying them the money so now I have to be my own doctor too? I wont do it . I think grief is a lot of my problem and being in a strange place and all the medical things that have happened to me in a few months and being old Love Phillipa ps when I was a kid I had temper tantrums I think I've been having them for l0years and no one will stop them. Love Phillipa
Posted by Tomatheus on September 19, 2006, at 23:31:32
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 19, 2006, at 8:21:47
> 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).That's quite a definitive statement. None of the above worked for me, although I've never tried Zoloft. Still, the source you quoted clearly stated that it's certain that Prozac, Paxil, and sugar pills do work, presumably for major depressive disorder. They did not work for me. So, would it be fair for me to refer to the statement that you quoted as a lie? Or are my comments simply invalid because I don't have an M.D.?
I guess it just amazes -- no, bothers is the more accurate word -- me how flawed some statements from "experts" can be. And that the thousands of dollars I've spent on ineffective treatments go toward paying "experts" who don't always speak the truth when it comes to describing how effective psychiatric treatments actually are.
I feel ripped off. That much is certain.
Tomatheus
Posted by Tomatheus on September 19, 2006, at 23:34:50
In reply to my last post for thread, posted by linkadge on September 19, 2006, at 8:27:58
> 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,
The generalization that you made bothers me. The difference between the efficacy of the "old" Nardil and that of placebo has been shown to be anything but small in an overwhelming majority of studies. Not all antidepressants are equal.
Tomatheus
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