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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Klavot on February 22, 2007, at 9:52:28
Hi all
Many people claim that modern antidepressants work only poorly - if at all - based on the apparently small margin between the efficacy of active and placebo compounds in many antidepressant drug trials. Now I'll come clean at the onset: I am not convinced that antidepressants don't work. I've seen the evidence for claiming that they don't work, but I'm just not convinced.
I've been thinking though, one of the problems with AD trials is that they generally do not employ a polypharmacological approach. They only test one drug at a time. In practice, psychiatrists tend to prescribe multiple drugs concomitantly. Do you think that if they were to do a trial on, say, Zoloft combined with Wellbutrin, or Remeron combined with Provigil, or Remeron combined with Effexor, etc., that the success margin between active and placebo arms of these trials might be substantially greater than the 10 - 20% that seems to be quite common in single-drug trials?
Klavot
Posted by Squiggles on February 22, 2007, at 10:44:07
In reply to Some ruminations on AD efficacy, posted by Klavot on February 22, 2007, at 9:52:28
I think that's an excellent point.
The combination treatment usually takes
place in the dr.'s office, and may not
be reported; if you do see it, it is in the interaction blurbs where contraindications and adverse reactions *have* been noted (e.g.
do not mix MAOIs with imipramine);
It's a lot work for the drug companies though, and the FDA and other regulatory organizations.Squiggles
Posted by Phillipa on February 22, 2007, at 12:05:39
In reply to Re: Some ruminations on AD efficacy, posted by Squiggles on February 22, 2007, at 10:44:07
Maybe too many combos too and ages, and sex. Love Phillipa but a good idea.
Posted by bassman on February 22, 2007, at 17:08:29
In reply to Some ruminations on AD efficacy, posted by Klavot on February 22, 2007, at 9:52:28
The STAR*D study did exactly that-add a second psychotropic agent if the first drug (Celexa) didn't help. It also had arms where there was a simple change of AD. For a particularly critical review of the study, see:
Posted by Squiggles on February 22, 2007, at 17:33:24
In reply to Re: Some ruminations on AD efficacy, posted by bassman on February 22, 2007, at 17:08:29
> The STAR*D study did exactly that-add a second psychotropic agent if the first drug (Celexa) didn't help. It also had arms where there was a simple change of AD. For a particularly critical review of the study, see:
>
> http://www.mindfreedom.org/know/psychiatric-drugs/anti-depressants/stard-d-wars-study-failure-on-antidepressants/Well, that's depressing. I hope BigPharma actually absorbs the public health care system in total; that way profit-motivated treatment and products will make a boomerang come-back. It just won't be good company practice to pick up the pieces. Seriously, I think the drug companies should run the whole medical system.
Squiggles
Posted by Klavot on February 22, 2007, at 18:27:26
In reply to Re: Some ruminations on AD efficacy, posted by bassman on February 22, 2007, at 17:08:29
My suggestion was measuring polypharmacology against placebo. STAR*D did not contain a placebo arm and made only partial use of polypharmacology.
The author of the linked article makes the mistake of extrapolating data from other AD trials to the STAR*D study, for example he states:
"And again, it is known from other antidepressant studies that had there had been a placebo control in stage two, the control would likely have done as well or better than STAR*D results."
My argument is precisely that a trial involving polypharmacology might yield substantially higher remission rates for the active treatment arm than traditional studies employing only monopharmacology.
The article is also full of ad hominem attacks on researchers which have financial ties to drug companies. One cannot simply discount research data as being biased from the fact that the researcher has previously received payments from the company concerned for services rendered.
Klavot
> The STAR*D study did exactly that-add a second psychotropic agent if the first drug (Celexa) didn't help. It also had arms where there was a simple change of AD. For a particularly critical review of the study, see:
>
> http://www.mindfreedom.org/know/psychiatric-drugs/anti-depressants/stard-d-wars-study-failure-on-antidepressants/
This is the end of the thread.
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