Posted by SLS on May 3, 2000, at 16:02:15
In reply to Re: Shorter trials: believe it! , posted by AndrewB on May 3, 2000, at 10:54:29
> > I'm not sure where you get your information on shorter trials, but I can speak from direct experience: I started Nardil 7 weeks ago and have only really noticed a major effect in the last week. To advocate shorter trials without some very serious research seems to be giving people who might really benefit from a med the wrong information. Just my two cents. Peter
>
> Thank you Peter for your input. It seems that some people, myself included along with various professionals have made false conclusions concerning the advisability of shorter trials. Î think it is very tempting to say shorter trials are appropriate in our impatience to arrive sooner at a remission of depression. Perhaps some people, with special metabolisms, benefit with short trials but I wonder how such people would be singled out from those that may take longer to respond.
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Thank you, Andrew. I am continually admiring of your temperament.There have been some pretty passionate subject headers here.
How we Babblers approach this issue, and the posture we take as we discuss it, will influence and affect many people here, possibly the majority. This bears a great deal of responsibility. In my opinion, it is incumbent upon us to realize that there will be some people here, lurkers included, who are on the cusp of making critical treatment decisions.
My mind has been open regarding the validity and applicability of the method proposed by Dr. Jensen of using short trials of antidepressants to treat depression. I consider it to be a reasonable approach when testing certain drugs in certain situations, but not for most others. I have posted an opinion detailing a dichotomy of these drugs in another thread. There are many reasons why I cannot at this time support short trial periods, some of which have not yet been mentioned.
Do some doctors let their patients linger too long on drugs that are ineffective, have intolerable side effects, and actually worsen the condition being treated? Of course. Should these doctors modify their treatment algorithms? Probably.
Let us not allow ourselves to fall into the trap of bipolar thinking.
My doctor, a clinical investigator who spends more time attending psychiatric conferences worldwide than he does in his office, has never heard of Martin Jensen, MD. This may or may not be important. Yesterday, I spoke to a clinical researcher at Columbia Presbyterian in NYC. His name is littered throughout the medical literature. He has never heard of Martin Jensen, MD. I described to him the premise (as described here by others) of his treatment method of performing short trials to screen for the *best* antidepressant. In short, he said that this idea is not consistent with everything he believes or has experienced. He offered some characterizations of these sorts of claims and the types of people who usually make them. This may or may not be important.
This doctor at Columbia did make one very salient point that I think is relevant and possibly revealing. To his knowledge, Dr. Jensen has never presented any of his ideas or research material at a psychiatric conference or symposium. The idea of using short trial periods would not withstand critical review by the psychiatric community. This is not because the members of this community are fixed to some dark-ages narrow-minded bias, but because such claims do not hold up to the scrutiny of simple questions. Regarding the explanations offered by Dr. Jensen as to how different drugs work, this researcher reacted by saying "we are not there yet". I found this to be an interesting choice of words. He then described to me in some detail why it is obvious that we are not.
If the proposals of Dr. Jensen would greatly improve the lives of the millions of people suffering from depression, why would he not offer them for peer review, rather than be content only to write a book? Perhaps he feels that he can reach more sufferers more quickly that way. He may passionately believe everything he claims. I remain dubious of his accuracy.
I have not read Dr. Jensen's book. There may be a great many valid and applicable perspectives that it has to offer. However, the use of short trial periods is the issue being discussed here.
I am playing with some ideas to further pursue the evaluation of the short-trial strategy using our Babble-board as a source of information.
In the mean time, I would not recommend to anyone that they terminate a trial of a "traditional" antidepressant (one for which depression is its primary indication) before allowing it at least three weeks to work. It may well take longer if dosage adjustments are required.
This post could have been much longer. There is quite a bit more that I could have added, and many aspects of this issue I haven't addressed here. I am sure this is true of the other participants in this discussion. It is of such great importance.
- Scott
poster:SLS
thread:31785
URL: http://www.dr-bob.org/babble/20000429/msgs/32075.html