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Re: News - Antidepressants Vindicated? linkadge

Posted by Larry Hoover on September 12, 2007, at 9:38:45

In reply to Re: News - Antidepressants Vindicated? sam123, posted by linkadge on September 10, 2007, at 14:06:09

> >And yet in the real world suicide rates for >teens and children are at the highest rates in >more than a decade during a period where >prescribing AD's for this age group declined.
>
> That doesn't mean anything yet. Only time will tell if one is actually causing the other. I'm sure the rate of prescriptions to adults has declined a bit too, has there been a corresponding increase in adult suicide?

There is some adult data included in the full-text. I highly recommend that you consider it.

> Like I said before, there could a reverse plaecbo effect at work wherby the precieved loss of a effective treatment is increasing depression.
>
> In order to truely determine if antidepressants are infact reducing suicde rates there would need to be a double blind placebo controlled study on the likelyhood of suicide, which is unlikely to happen due to ethics.
>
> Linkadge

I think there's more evidence already collected, from large ecological studies conducted in the U.K. They demonstrated a relatively brief uptick in suicidal events during the immediate period upon introducing the antidepressant treatment. However, if the longer view is taken (i.e. past the first 6 or 8 weeks), suicidal events were dramatically reduced. It was also discovered that the most critical period for suicidality comes immediately before treatment is initiated, a finding comfirmed by Veterans Administration data recently published.

If you consider the more typical long-term treatment found in normal clinical practise, the limitation of most published studies to data obtained during the first six, eight, or twelve weeks of treatment actually biases the data towards capturing the treatment-emergent uptick in suicidality, which is an effect common to every class of antidepressants. In fact, it is just this effect that spurred the development of the SSRIs, as the prior generation of antidepressants, the TCAs, are far more toxic in overdose.

I think there is a major logical flaw in generalizing from short-term efficacy trials to the broader experiences of depressives obtaining treatment in the community. There is likely nothing more artificial than a clinical trial. The simple act of controlling variables reduces generalizability. The more controlled, the less generalizable the resultant data become.

Lar

 

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poster:Larry Hoover thread:781684
URL: http://www.dr-bob.org/babble/20070911/msgs/782420.html