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Re: placebo vs. antidepressant sam123

Posted by Larry Hoover on September 14, 2007, at 9:15:44

In reply to Re: placebo vs. antidepressant, posted by sam123 on September 13, 2007, at 22:51:11

> >
> > Thought-provoking, all in all.
> >
> > Lar
> >
> >
>
> Emperor ? Clothes ?

It strikes me that if placebo response is adversely influenced by e.g. flexible dosing, whereas antidepressant response is enhanced (and more like standard clinical practise, also), then we might actually find methodologies to strip away the artefact of clinical trial structure, and reveal the medication effect itself. Well, at least do a better job of it.

IMHO, depression is multifactorial in etiology. Even with a genetic predisposition, environmental factors are powerful modulators. Even if one assumes a purely biological depression, one would never lose one's humanity, i.e. responsiveness to personal attention, caring, support, and love.

In comparisons between studies, Khan (and many others, but I didn't reference them) discovered highly significant correlations between placebo response and antidepressant response. Both tended to be lower, or both tended to be higher. This covariance has the unfortunate mathematical effect of obscuring the drug effect in the more responsive trial environments, despite findings overall that more people found remission.

The gender bias towards placebo response in women also surprised me. I can think of sociological explanations, such as persistance of the dismissive treatment of women from earlier times (now more subtly applied, I'd imagine), or differential response to social cues.

The bias towards selecting moderately depressed subjects with no comorbid conditions actually predisposed towards placebo responsiveness.

The overall point is that everyone is concluding the drugs don't work, without considering the effects of the methodology. We don't know the effects of the methodology, but those effects are non-zero, and always act to obscure the true medication effect. They diminish our ability to see the truth.

Lar

 

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poster:Larry Hoover thread:781684
URL: http://www.dr-bob.org/babble/20070911/msgs/782832.html