Posted by Cam W. on April 27, 2000, at 17:11:15
In reply to Re: Cam- how to read the article, posted by LD on April 27, 2000, at 8:12:06
> Cam, I read the article by putting "antidepressants" in the search box on washingtonian online and it came up. Try that and see if it works for you.
Thanks LD. The article was from the December,1997 issue of the Washingtonian. It was not as scathing as I thought it would be, but it did not approach the subject of antidepressants from a scientific point of view. The author was writing for the masses. A few statements that he made did stretch reality a little.
Thomas Moore (the author) states that antidepressants "routinely fail to produce clinical benefit in clinical testing". All antidepressants that have been released have worked significantly better than placebos or they would not have been released.
Moore also commented on a large placebo effect. True, some studies do have large placeo effects, but there are many explanations for these, especially when dealing with the selected group used for clinical testing. The placebo effect rate that Moore quotes (2 out of 3) is false. I have only seen one incredibly high placebo response rate of 54%. Most run in the 20% to 30% range, which I agree is high.
Moore also implies that withdrawl effects mean that antidepressants are habit forming. There is absolutely no correlation between these two concepts.
Moore uses Serzone to show that antidepressants do not work much better than placebos. He picks the worst of the clinical studies on the drug to make his point. He only talks about clinical studies of 6 weeks. We all know that it can take more than 6 weeks to fully resolve depressive symptoms in most people. Therefore, at 6 weeks, it will look like the antidepressant is working no better than placebo. Also, Serzone does not work for most people, only in a select group. He should have shown evidence for 6 month trials of any antidepressant and all would have worked significantly better than placebo.
Moore also compares clinical trial drop out rates of antidepressants with drop out rates of anticholesterol drugs. This is like comparing apples and oranges. He could have compared ADs to some heart meds and the drop out rates for the heart meds would have been much higher than the drop out rates for the ADs.
Moore also says that Ritalin and Xanax work just as well as the antidepressants for depression. True, but the side effects, addiction potential and toxicity of these drugs would not make them first line agents in depression. Xanax does bind to the GABA-A receptor, thought to have antidepressant activity.
Moore advances the stigma of ECT by falsely claiming that ECT causes "long lasting harm to the brain". This is wrong. ECT is extremely safe. ECT is the antidepressant treatment of choice in pregnant women and for people over 75 years.
Moore also shows suicide stats with ADs versus placebos. One reason that the suicide rates for people taking antidepressants is that the AD is starting to resolve the depression. A depressed person with suicidal ideation is able to act upon this ideation when the depression starts to resolve.
My take on the article.
Again, I am sorry to BJ for my sarcastic post of yesterday. I hope you can forgive me. Sincerely - Cam W.