Psycho-Babble Medication Thread 534296

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Battle Brews Over Antidepressant Use

Posted by jerrympls on July 27, 2005, at 15:24:59

Another interesting article in light of Tom Cruise's ignorant views on psychiatry and medication use.

Jerry

----------------------

Battle Brews Over Antidepressant Use
2 Researchers Say They Are Ineffective and Overused
By Salynn Boyles
WebMD Medical News

July 15, 2005 -- Around water coolers everywhere, people are still talking about Tom Cruise's widely publicized comments late last month against antidepressants. And some experts agree with him.

In an interview with the Today Show's Matt Lauer, the actor strongly condemned the use of psychiatric drugs and claimed that there is no proof that chemical imbalances in the brain drive depression. Since then, psychiatrists across the U.S. have passionately defended the drugs.

The debate over whether Cruise has a point or has no clue will no doubt continue. But a psychiatrist in Britain who has long spoken out against antidepressant use is making many of the same points in an essay published in the July 16 issue of the British Medical Journal.

However, an American expert questions the British psychiatrist's objectivity.

'Have to Be Skeptical'

Joanna Moncrieff, who is a senior lecturer in psychiatry at University College London, argues that the clinical evidence does not justify the use of antidepressants -- particularly selective serotonin reuptake inhibitors (SSRIs) -- as the treatment of choice for moderate to severe depression.

SSRIs are the most widely prescribed class of antidepressants and include:

Celexa
Luvox
Paxil
Prozac
Zoloft
"The bottom line is that we really don't have any good evidence that these drugs work," she tells WebMD. "I think we have to be highly skeptical. We have been treating all comers with antidepressants for years now, and we have seen an increase rather than a decrease in depression at the community level."

In the newly published essay, Moncrieff and psychology professor Irving Kirsch, PhD, call on public health officials in Britain to reconsider their policy of recommending antidepressants as the first treatment for moderate to severe depression.

Moncrieff and Kirsch have each published research reviews suggesting that antidepressants are only slightly more effective than placebo for treating depression.

In an analysis published in 2002, Kirsch reviewed 47 studies involving the six most widely prescribed antidepressants. He concluded that 80% of the medication response in the patients treated with the antidepressants was duplicated in the patients on placebo. Moncrieff came to a similar conclusion in a review she published in 2001.

But psychiatrist Darrel Regier, MD, MPH, says there is plenty of clinical evidence showing that antidepressants work and that the reviews failed to include important studies showing just that.

Regier, who is director of research for the American Psychiatric Association, noted that Moncrieff is co-founder of a group in the U.K. that questions the very existence of depression and the need to treat it.

"She is of the persuasion that medical disorders are a myth and a social construct, and that there is no biological basis for them," he tells WebMD. "I think what she has done, given her bias, is emphasize the negative [antidepressant] studies and mischaracterize many other ones."

He points out that in a 1997 essay that Moncrieff wrote titled "Psychiatric Imperialism: The Medicalization of Modern Living," she rejects accepted treatments for patients with schizophrenia.

In the essay, Moncrieff writes that society should instead accept the idea that some schizophrenics "may chose to lead lives that appear bizarre or impoverished."

Chemical Imbalance Debate

In his July 24 Today Show appearance, Tom Cruise said he did not believe in psychiatry, and he called antidepressants and other psychiatric drugs "very dangerous." Cruise also said that "there is no such thing as a chemical imbalance."

Moncrieff tells WebMD that she was only vaguely aware of Cruise's comments, but she says the actor is "absolutely right" to reject the idea that chemical imbalances are responsible for depression.

The most widely used antidepressants target chemicals within the brain, including serotonin and norepinephrine.

"People who seek help for depression actually have all sorts of different problems, and I don't think that they all share similar brain chemical imbalances," she says. "If we just focus on the chemical serotonin, nobody has been able to show that an abnormality in serotonin has been demonstrated in people with depression."

But once again, Regier says Moncrieff is simply rejecting a large body of evidence that doesn't fit her worldview.

"It is clear that antidepressants which focus on altering the neurotransmission of norepinephrine and serotonin are effective in the treatment of depression," he says. "The brain functions chemically, and the chemical changes that occur with depression are the same, regardless of the reasons for it."

Article link: http://my.webmd.com/content/Article/108/109044.htm

 

Re: Battle Brews Over Antidepressant Use

Posted by blueberry on July 28, 2005, at 5:13:00

In reply to Battle Brews Over Antidepressant Use, posted by jerrympls on July 27, 2005, at 15:24:59

I wonder why prozac lifted my depression markedly beginning on day 2?

Same thing with zyprexa.

If some critic thinks that is a placebo effect, they are ignorantly mistaken. Placebo effects do not continue to provide improvements that last for years.

I've been in psychiatric trouble nearly all my life. Prozac and zyprexa have made most of those troubles disappear, and they have worked for at least 3 years so far. That's no placebo.

Chemical imbalance? That might not be accurate. But definitely the meds do cause something in the brain to change that effects emotion.

 

Re: Battle Brews Over Antidepressant Use blueberry

Posted by jerrympls on July 28, 2005, at 9:08:12

In reply to Re: Battle Brews Over Antidepressant Use, posted by blueberry on July 28, 2005, at 5:13:00

> I wonder why prozac lifted my depression markedly beginning on day 2?
>
> Same thing with zyprexa.
>
> If some critic thinks that is a placebo effect, they are ignorantly mistaken. Placebo effects do not continue to provide improvements that last for years.
>
> I've been in psychiatric trouble nearly all my life. Prozac and zyprexa have made most of those troubles disappear, and they have worked for at least 3 years so far. That's no placebo.
>
> Chemical imbalance? That might not be accurate. But definitely the meds do cause something in the brain to change that effects emotion.

Blueberry-
I completely agree with you. My depression has been so resistant to medications that I've WISHED for a placebo response. I don't doubt that the placebo response is real in certain situations - however, I think it occurs only in a very small minority of mood disorder treatment cases.

 

Re: Battle Brews Over Antidepressant Use

Posted by linkadge on July 28, 2005, at 16:00:52

In reply to Re: Battle Brews Over Antidepressant Use blueberry, posted by jerrympls on July 28, 2005, at 9:08:12

I think they may work, but for reasons that we have not fully quantified.

The SSRI's for instace increase allopregnalone several fold, which is a potent gabaergic neurosteroid.

So it may not be a serotonin imballence per se, but that does not mean they are without effect.


Linkadge

 

Antidepressants

Posted by med_empowered on July 28, 2005, at 18:00:38

In reply to Battle Brews Over Antidepressant Use, posted by jerrympls on July 27, 2005, at 15:24:59

Hey. I've had both successes and failures with antidepressants and combo therapy, so skeptical research like this is very refreshing. My own take on it is that while antidepressants obviously do *something*, this *something* may or may not relieve depression/anxiety in patients...I also think the chemical imbalance theory is waaaay oversimplified and excludes a lot of important factors, such as life factors and social factors. I think its important to question EVERY treatment we have available, instead of treating them delicately; scientific inquiry is based on a no-holds barred, question-everything approach with the idea of pursuing knowledge and (in this case) better treatments/products. If we continue to buy the line that today's anti-depressants are very effective in spite of lots of data that shows they sometimes aren't that great, and that they come with lots of side effects for many people, how will we progress? Bottom line, I think, is this: anti-depressants help some people, but they're definitely not "the" answer for treating depression. In making informed decision about health care, consumers need to be told that some studies do in fact show little difference between anti-depressants and placebo, and they need to know that there are side-effects, which can be severe for some people (or non-existent for others). I think data like this is a call for psychiatry to take a more humble, inquisitive approach to treatment, rather than simply repeating the "antidepressants effectively treat depression" mantra over and over. There's no need to ditch the antidepressants completely, but it would be nice to explore new drugs, new theories, and new understanding of depression and emotional life in general.

 

That was well writtain. med_empowered

Posted by linkadge on July 28, 2005, at 20:28:18

In reply to Antidepressants, posted by med_empowered on July 28, 2005, at 18:00:38

That post was extremely well writtain. That summs up my stance.

I am not against the idea of an "antidepressant". We need to find a middle road. When people start to backlash against them, they often make comments that are somewhat of an exageration. But when doctors try to defend against such comments they tend to build the drugs up into something they're not. The truth is somewhere in between, where exactly is a mystery.


Linkadge


 

Re: That was well writtain.

Posted by jerrympls on July 28, 2005, at 20:41:28

In reply to That was well writtain. med_empowered, posted by linkadge on July 28, 2005, at 20:28:18

> That post was extremely well writtain. That summs up my stance.
>
> I am not against the idea of an "antidepressant". We need to find a middle road. When people start to backlash against them, they often make comments that are somewhat of an exageration. But when doctors try to defend against such comments they tend to build the drugs up into something they're not. The truth is somewhere in between, where exactly is a mystery.
>
>
>
>
> Linkadge
>
>
>
I do agree as well. The idea that serotonin is the "magical" cure-all for depression is narrow thinking and it's absurd that doctors and researchers have become complacent with this theory. There are SO many more neurotransmitters from acetylcholine to nicotinic to opioid - not to mention other systems within the brain - i.e.: the HPA balance, the role of cortisol, testosterone and estrogen - and how these other systems tie in with each other - they all for a symbiant circle.

Psychiatry is basically an artform - and most of the time it's just a doctor taking a stab in the dark.

If we truely lived in a 'Prozac Nation' - wouldn't we all be doing just great? I think it's also important to point out that just 5-10 years ago psychiatrists & drug companies were saying medication helps 80-90% of depression sufferers - and now they can barely support evidence that indicates only 70% are helped - if even that much.

THey've been stabbing in the dark for too long - it's time for them to try and find a light socket and screw in a lightbulb.

Jerry

 

Re: That was well writtain.

Posted by Iansf on July 28, 2005, at 23:30:40

In reply to Re: That was well writtain., posted by jerrympls on July 28, 2005, at 20:41:28

Everyone I know with depression who has tried antidepressants has found at least one of them effective. Everyone. And that's after they failed to find relief with non-medicinal treatments. There are clearly people who have not benefited, or at least not benefited from the meds they tried, but in my experience only a minority of people suffering from depression do not improve on meds. The primary issue for most people is side effects, not effectiveness of the drugs themselves. The situation appears to be somewhat different for anxiety, social phobia, schizophrenia, ocd, etc. But it's my impression that almost everyone with depression can find at least one effective drug. The question is, can they tolerate it?

 

agreed Linkadge and med_empowered

Posted by MM on July 29, 2005, at 2:23:22

In reply to Re: That was well writtain., posted by Iansf on July 28, 2005, at 23:30:40

I hate to be a naysayer because if SSRI's/antidepressants help people, I think that's a wonderful thing. The SSRI's were just awful for me though and I took them when I was a teenager before all the warnings and I just think it was a big mistake for me and set me back.
MM

 

Re: That was well writtain.

Posted by linkadge on July 29, 2005, at 6:46:05

In reply to Re: That was well writtain., posted by Iansf on July 28, 2005, at 23:30:40

"The primary issue for most people is side effects, not effectiveness of the drugs themselves."

I beg to differ, but the drugs are ineffective for a larger portion of people than is commonly recognized. Poop-out is not uncommon. There was only a small portion of time in my life that I could attest to getting true relief from them.

I have about 5 good friends that I know of who are on AD's, and all of them say they pooped out, and that they are more or less back to feeling like trash. All of whom are on ever increasing doses, and ever more complicated coctails.

I wish I could give them a better report, but its not all that conclusive in my experience.


Linkadge

 

Re: Antidepressants

Posted by SLS on July 29, 2005, at 8:09:21

In reply to Antidepressants, posted by med_empowered on July 28, 2005, at 18:00:38

> There's no need to ditch the antidepressants completely, but it would be nice to explore new drugs, new theories, and new understanding of depression and emotional life in general.

This is PRECISELY what has been going on in neuroscience and psychiarty since I first stuck my nose in medical journals in 1983. I doubt there is much that has been overlooked, despite how much there is yet to be discovered. I can understand how people whom are not very familiar with this basic and clinical research would view the state of the art as being impotent. Data comes in quickly. Unfortunately, understanding does not.

I would just like to add my usual caution that people on Psycho-Babble whom have demonstrated treatment resistence not generalize their experiences to the general population and the majority of those being treated.

It might be time to use different paradigms for the testing of humans for the efficacy of antidepressants. Placebo controls seem to confound the interpretations of results, leaving many investigations meaningless. This is an ongoing debate, and the key fact being considered is that the rate of placebo effect is too high, despite randomization. Many researchers - Fredrick Quitkin being perhaps the most prominent - have been looking very closely at the nature of the placebo response and how it affects the interpretation of clinical trials of antidepressants.


- Scott

 

We need placebo

Posted by med_empowered on July 29, 2005, at 16:23:58

In reply to Re: Antidepressants, posted by SLS on July 29, 2005, at 8:09:21

Here's the thing: if the argument is that depression is a medical condition that is best treated medically, we *need* a placebo control--this is, afterall, how we evaluate all other medical treatments (including other psychotropics, such as neuroleptics or anxiolytics). The FDA recognizes the importance of the placebo effect--thus, all ADs have to prove more effective than placebo in at least 2 large scale, randomized trials. It may well be that the nature of depression makes it more responsive to placebo. Then again...many depressive episodes are self-limiting, so if one left a patient alone for 6-12 months the odds of that individual recovering from depression w/o any sort of intervention are pretty good, too. Instead of questioning placebo--which is a necessary control for medical research-- I think we need to question our current treatments and what seems to be the prevailing assumption that depression is best treated with antidepressants. Given the billions upon billions of dollars spent by individuals, insurance companies, and various government health agencies on antidepressants and other mental health treatments, I think that if anything we should hold these treatments--which, though sometimes helpful often are expensive and full of side-effects-- to a higher standard than the one to which they are now held, not a lower one. Some researchers argue (and I agree) that a better control than simple "placebo" would be so-called "active placebo". Basically,, an "active placebo" would produce minor side effects--drowsiness, for instance-- that are commonly associated with psychotropic treatment. By adding a few well-known side effects, one could tell even better the precise difference in efficacy between the control arm and the treatment arm...in other words, does Prozac help people because of some action on the brain, or do Prozac's side effects make the user think they're getting "strong medicine" and thus heal them primarily through an (active) placebo effect?

 

Re: We need placebo med_empowered

Posted by ed_uk on July 30, 2005, at 3:19:45

In reply to We need placebo, posted by med_empowered on July 29, 2005, at 16:23:58

Hi Med,

Active placebos are interesting. The problem is: how can you be sure that the active placebo isn't an antidepressant itself?!

~Ed

 

good point

Posted by med_empowered on July 30, 2005, at 7:16:05

In reply to Re: We need placebo med_empowered, posted by ed_uk on July 30, 2005, at 3:19:45

hey! I was reading the other day that alot of our psychiatric drugs (particularly the old-school neuroleptics and the antidepressants) were derived from "first-generation" antihistamines; Prozac from Benadryl, Thorazine from (I believe) chlortri... (I forget the rest of the name). Anyway, lo and behold, some of these parent compounds can be pretty potent psychotropics in and of themselves.

 

Re: We need placebo

Posted by SLS on July 30, 2005, at 10:19:03

In reply to We need placebo, posted by med_empowered on July 29, 2005, at 16:23:58

Hi.

> Here's the thing: if the argument is that depression is a medical condition that is best treated medically, we *need* a placebo control-

Not unless the placebo effect is real and/or part of the natural course of the illness in those "responding" individuals. A 30-35% response rate to placebo makes clinical trials almost meaningless. I have often thought that the high rate of placebo response was the result of poor inclusion/exclusion criteria. When one includes only a population of depressives rated as severe, the placebo response approaches zero while the response rate remains at 65-70%.

Just a spur of the moment idea: It might make sense to use a placebo-placebo control in addition to the active group, and extend studies for 4 months rather than 6 weeks. A high percentage of placebo responders tend to respond very early in a trial and relapse after 10 weeks. I would separate out anyone whom has continued to be a placebo responder by 10 weeks. I would then crossover the placebo non-responders to active compound and continue them for another 6 weeks. It would be preferable to use an active placebo, or those crossing over will be again subject to a placebo effect when the investigational compound is introduced and its side effects recognized. Now one may more easily compare the rate of response to non-response.

The desirability of using placebos in trials of antidepressants is more complex than this. Since there is much more to this issue than I am capable of presenting right now, I might suggest you start researching the matter using an Internet search engine using keyword phrases like:

- placebo Quitkin
- placebo antidepressants meaningless

> -this is, afterall, how we evaluate all other medical treatments (including other psychotropics, such as neuroleptics or anxiolytics).

I am not knowledgable enough to be able to speak to all other medical interventions. Certainly, ethical considerations must prevent the use of a placebo in some circumstances.

> The FDA recognizes the importance of the placebo effect--

Some people tend to propel the FDA to a status of infallability at times and bash the FDA at others. I would like to leave the FDA out of this debate and include only the research and medical commentary itself.

> Then again...many depressive episodes are self-limiting, so if one left a patient alone for 6-12 months the odds of that individual recovering from depression w/o any sort of intervention are pretty good, too.

One might consider withdrawal of the active compound for two weeks after a response, and then rechallenge if a relapse ensues. Stuff like this has been done before.

> Instead of questioning placebo--which is a necessary control for medical research--

I am not convinced that placebo controls are necessary for medical research. Like I said, there is much debate surrounding this issue.

These drugs. Perhaps our studies of these drugs do not.


- Scott

 

Re: We need placebo SLS

Posted by ed_uk on July 30, 2005, at 12:49:48

In reply to Re: We need placebo, posted by SLS on July 30, 2005, at 10:19:03

Hi Scott,

>It would be preferable to use an active placebo.....

.....but what if the active drug produced a higher incidence of side effects than the active placebo. Due to the high incidence of side effects, people given the active drug may view it as being a 'powerful' drug, this may increase the placebo effect, thus suggesting that an (ineffective) drug was more effective than placebo.

>One might consider withdrawal of the active compound for two weeks after a response, and then rechallenge if a relapse ensues.

What about withdrawal symptoms?

Kind regards

~Ed

 

Re: We need placebo ed_uk

Posted by SLS on July 30, 2005, at 16:24:39

In reply to Re: We need placebo SLS, posted by ed_uk on July 30, 2005, at 12:49:48

Hi Ed.

> >It would be preferable to use an active placebo.....
>
> .....but what if the active drug produced a higher incidence of side effects than the active placebo.

That is always a difficulty whenever crossover investigations are performed. When I participated in this type of study with inactive placebo, I just figured they had simply increased the dosage on me.

> Due to the high incidence of side effects, people given the active drug may view it as being a 'powerful' drug,

They would not be aware of the crossover design of the study, only that they may or may not receive placebo.

> this may increase the placebo effect,

But placebo responders will have been removed from this phase of the study by the end of 10 weeks.

Now you are beginning to understand the power of the placebo effect when it comes to depression. It is a difficulty that must be addressed in order to evaluate the true efficacy of antidepressant medication.

> > One might consider withdrawal of the active compound for two weeks after a response, and then rechallenge if a relapse ensues.

> What about withdrawal symptoms?

This sort of procedure has been carried out in the past. Perhaps a taper could be performed over the course of two weeks rather than an abrupt continuation.


- Scott

 

Re: We need placebo SLS

Posted by ed_uk on July 30, 2005, at 16:47:10

In reply to Re: We need placebo ed_uk, posted by SLS on July 30, 2005, at 16:24:39

Hi Scott,

>But placebo responders will have been removed from this phase of the study by the end of 10 weeks.

I don't think people are either placebo responders or non-responders though. People may respond to one placebo but not another, depending on how effective them deem the treatment to be. For example, someone might respond to sham ECT but not a placebo tablet. People might get a 'better' placebo effect from a drug which cause more side effects, because they assume that it's more 'powerful' than a drug which causes milder side effects.

>This sort of procedure has been carried out in the past. Perhaps a taper could be performed over the course of two weeks rather than an abrupt continuation.

I agree. A taper would be very important.

Kind regards

~ed

 

Re: We need placebo ed_uk

Posted by SLS on July 30, 2005, at 20:50:13

In reply to Re: We need placebo SLS, posted by ed_uk on July 30, 2005, at 16:47:10

My idea was a quickie. It isn't something I've invested more than a few minutes thinking about. However, I think the way that we approach evaluating the efficacy of antidepressants must be viewed in the context of the high rate of placebo response. Perhaps our statistical methods can be refined to take the high placebo response into account. Perhaps it is as simple as adjusting our perspective and expectations. That an antidepressant is "only" 45% (30% placebo versus 75% active) better than placebo is a large number within the context of clinical trials of depression. Even if the percentage of active compound responders was as low as 60%, this would still represent a treatment superiority of 200% over placebo.

I would still want to look to do studies in which the inclusion criteria included only the more chronic and severe cases of depression. I bet the placebo response would be closer to 5-10%. What would happen if we included only those severe cases where cortisol levels were abnormal?

What are we treating? If 30% of those included in the study are primarily psychologically depressed rather than biologically, but still qualify under DMS IV criteria for major depressive disorder, how would we want to interpret a placebo response of 30%?


- Scott

 

Re: We need placebo SLS

Posted by ed_uk on July 31, 2005, at 6:56:17

In reply to Re: We need placebo ed_uk, posted by SLS on July 30, 2005, at 20:50:13

Hi Scott,

>However, I think the way that we approach evaluating the efficacy of antidepressants must be viewed in the context of the high rate of placebo response.

I agree. The placebo response is very high and seems to be rising - I've had the impression that new studies seem to have higher placebo responses than older ones. I think you're right that it's related to the selection criteria..... and perhaps due to impressive nature of being in a study of a new drug.

>I would still want to look to do studies in which the inclusion criteria included only the more chronic and severe cases of depression.

I agree. Also, drugs with a novel mechanism of action ought to be tested on patients who are resistant to a few current therapies eg. at least one SSRI, one TCA and Effexor.

>What would happen if we included only those severe cases where cortisol levels were abnormal?

Probably a poor placebo response and a good response to something like nortriptyline.

>If 30% of those included in the study are primarily psychologically depressed rather than biologically, but still qualify under DMS IV criteria for major depressive disorder, how would we want to interpret a placebo response of 30%?

It's always difficult to do clinical trials of drugs for MDD due to the relatively heterogeneous group of patients included - despite the selection criteria (which exclude many patients who'd be treated with ADs in practice).

Also, people with definite biological abnormalities can respond to placebo eg. post-operative pain could be relieved by a saline injection (which was supposed to be morphine).

Kind regards

~Ed

 

Re: We need placebo ed_uk

Posted by SLS on July 31, 2005, at 7:44:25

In reply to Re: We need placebo SLS, posted by ed_uk on July 31, 2005, at 6:56:17

Another aspect of the study of individual compounds as antidepressants is that any one antidepressant may work for only a fraction of an ultimately responsive population. We know this to be true. Yet, we place demands upon new drugs that they be able to produce response rates tantamount to being silver bullets. We don't ask this much of other drugs in most other illnesses. If each of 5 antidepressant drugs work in only 35% (compared to the generally observed 70%) of cases in different sets of people, depending on the heterogeneity of the population and the degree of overlap, you could conceivably cull a 95% rate of remission. An example of this shortsightedness is the rejection by the FDA of gepirone, a drug that did not show as robust a statistical advantage over placebo as was desired by that agency. Yet, this drug does seem to be effective enough to get some people well. From what I understand, new data on gepirone is to be included in a resubmission to the FDA by the manufacturer.

By the way, my silly little idea did not call for the abolition of placebos, just a different way of designing placebo-controlled studies. It doesn't look like it would be a viable solution, but I think it helps bring into focus the difficulty in evaluating antidepressants against placebo when a rate of placebo response of 1/3 has yet to be explained and adjustments made to the design of studies, their statistical evaluation, or perhaps only our unreasonable expectations of a single drug.


- Scott

 

Re: We need placebo SLS

Posted by ed_uk on July 31, 2005, at 13:39:42

In reply to Re: We need placebo ed_uk, posted by SLS on July 31, 2005, at 7:44:25

Hi Scott,

>Another aspect of the study of individual compounds as antidepressants is that any one antidepressant may work for only a fraction of an ultimately responsive population. We know this to be true.

Absolutely. Now we need a better method of determining which drug is likely to work for a particular individual!

>Yet, we place demands upon new drugs that they be able to produce response rates tantamount to being silver bullets.

Very true..... and we'll never have a silver bullet which effectively treats all forms of depression.

>If each of 5 antidepressant drugs work in only 35% (compared to the generally observed 70%) of cases in different sets of people, depending on the heterogeneity of the population and the degree of overlap, you could conceivably cull a 95% rate of remission.

Excellent point. We need a variety of drugs with different mechanisms of action so that this can be the case. We don't need another ten SSRIs! Hopefully we'll soon have Valdoxan...... and I do hope that none of the TCAs or MAOIs are discontinued. It would be a truly depressing situation if the SSRIs and SNRIs were all we had to work with. I remember when my doctor said that he'd 'never needed to use an MAOI'. What rubbish. What about his patients who were chronically incapacitated - living in psychiatric residential homes?

In the UK at least, we urgently need to move away from the idea that people who's depression doesn't respond to SSRIs and SNRIs are untreatable. Psychiatrists must be willing to utilise a wide variety of treatment options in order to help as many patients as possible.

>From what I understand, new data on gepirone is to be included in a resubmission to the FDA by the manufacturer.

http://news.biocompare.com/newsstory.asp?id=85989

>placebo response of 1/3

If the studied population consists mainly of people suffering from relatively mild acute depression, spontaneous recovery might account for the high rate of 'placebo' response.

 

Re: We need placebo SLS

Posted by Kon on July 31, 2005, at 13:55:43

In reply to Re: We need placebo, posted by SLS on July 30, 2005, at 10:19:03

> I am not convinced that placebo controls are necessary for medical research. Like I said, there is much debate surrounding this issue.

I'm sure pharmaceutical companies would love such a scheme. Wouldn't exclusion of placebo controls result in a high likelihood that ineffective antidepressants/anxiolytics and other drugs be unnecessarily foisted on the public?

Also not to downplay Dr. Quitkin's findings but even his recent study excluded patients over 65 and those with very severe depression. Dr. Quitkin has also had some associations with Pfizer and been a speaker and on advisory board for Eli Lilly.

As a pharmacy student, I'm really having trouble to know what the "truth" is wrt efficacy of a given medication and what is best for the patient since trials funded by pharmaceutical companies rarely produce unfavourable results. I'm becoming more skeptical of not just the efficacy of many psychotropics but also anti-cholesterol and anti-hypertensive drugs. Can research funded by pharmaceutical companies truly be unbiased or are medical journals becoming an extension of the marketiung arm of pharmaceutical companies as some researchers/academics have argued? Dunno...And I'm saying this even though I do believe that certain drugs are extremely useful and life-changfing for patients. For example, I've had great relief with benzos for my anxiety whereas SSRIS and CBT were totally useless.

 

Re: We need placebo Kon

Posted by ed_uk on July 31, 2005, at 14:36:27

In reply to Re: We need placebo SLS, posted by Kon on July 31, 2005, at 13:55:43

Hi Kon,

I'm a pharmacy student too.

~Ed

 

Re: We need placebo

Posted by Kon on July 31, 2005, at 17:53:46

In reply to Re: We need placebo Kon, posted by ed_uk on July 31, 2005, at 14:36:27

Hi Ed,

I have 2 more years left. Boring so far...It seems the most interesting stuff in pharmacy can befound on the internet. Good luck in your studies.


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