Posted by linkadge on May 23, 2006, at 17:14:17
In reply to Re: Statistical question on SSRIs - ADDENDUM » linkadge, posted by Larry Hoover on May 22, 2006, at 17:58:03
>When a recent study was published, and posted >here, you dismissed the evidence made available >by it. Pre-treatment suicidality was >substantially higher than post-treatment >measures, in the study population.
I dismissed nothing. Different studies say different things. You believe what you want to.
>If you only look at the immediate post->treatment period, then your a priori >assumptions force the effect of treatment >itself to be your new baseline for the >observation period. However, if you compare pre->treatment to post-treatment, the suicidality is >substantially reduced. You are blinded by your >experimental protocol, link.
Often in such studies, if a researcher has reason to believe that a treatment is indeed increasing suicidiality, then the treatment is withdrawn.
Many studies are simply ended if researchers believe that the active treatment is causing suicidialtiy. So, is that information taken into consideration? Probably not. In addition, I don't trust studies in general.
>In other words, under the paradigm you >envision, you are doing a within-groups >comparison, but you don't realize it. They're >all treated subjects, but you're thinking as if >the placebo is not treated. That is not the >case. Placebo is a treatment.Of course placebo is treatment. It is treatment without the burdon of side effects. This is why the placebo often produces a more robust clinical effect.
>If anybody did kill themselves, and it was part >of your experimental hypothesis, then you would >be forced to terminate the study. That's what >I'm saying, link.
No, thats what I am saying. Think of all the clinical trials that we don't know about. The trials which might support my hypothesis, but were ended because of the conclusions which were reached.
>You can't do the research you >envision, on >ethical grounds. You'd never get >it past an >ethics committee. And even if you >did, the >moment you collected any evidence, you'd have >to shut it down.....before you had any >statistically meaningful evidence.You seem to think that my opinion is going to be swayed in any way by my lack of conclusive "scientific" evidence. I never set out to try and convince anybody but myself.
There are plenty of bits and pieces of information which I piece together to come to my conclusions. Studies are just studies. They need to be taken with a grain of salt.
For instance. I saw a study intitled: "Wellbutrin has strong Antianxiety Properties", published in the journal of clinical psychiatry. Do I believe such a study? No, I think it is GSK trying to attack the one reason that their medication is not prescribed more, which is that it is precieved to increase anxiety. Straight from the boardroom: "Design us a study that shows Wellbutrin does not increase anxiety"
>We know the extent of the problem. It seems, >though, as if you wish to extrapolate your >experience to all people. The study I linked >to, above, is clearly inconsistent with your >thesis.
We do not know what the extent of the problem is. That is why we are asking ourselves (and currently creating the studies to test the hypothesis) whether or not the increased indicidence of SSRI induced suicidiality actually extends to adults.
>I only wish *any* science was that clear cut. >With people as subjects...??? Forget about it.I am not saying that the science is that clear cut. All I am saying is that it is a binary situation. Either the person was going to kill themselves anyway and the med had no effect. Or, the person was not going to kill themselves and the med pushed them over the edge. No, I realize nobody can know for sure, unless we had a time machiene. But it can still be considered a binary situation nonetheless.
>Did we stop using MAOIs? No. Did we modify the >drugs? No. Did we manage patients better, based >on what we learned? Yes.
Well, the rate of prescription of MAOI's is significantly less than what it would have been had the meds not had this problem. So in a sence, yes, we did stop using the drugs (though not entirely) based on our findings. Many doctors believe they are superior antidepressants, but they are shunned because of this side effect. Perhaps when newer antidepressants come out, doctors will say, "oh we don't like to use the SSRI's anymore cause they can make some people suicidal".
>The MAOIs haven't changed one lick. We did. We >manage them better. We have a medical >management issue here, not a drug issue. The >drugs are what they are. We either manage them >in such a way that nobody gets hurt, or we >don't.I wish it was that easy. If doctors believed that the potentially lethal side effects of the MAOI's could be completely mannaged, then the drugs would likely hold a larger portion of the market. But the fact remains, that even the best management cannot completely eliminate their risks. Its the same with SSRI's. There is absolutely no way that doctors can contain SSRI induced suicidialty. Perhaps it can be limited, or reduced. All the management in the world is not going to change the nature of the drug, or the nature of how people respond to it. We can't lock people up till they get over that "hump".
Linkadge
poster:linkadge
thread:640557
URL: http://www.dr-bob.org/babble/20060520/msgs/647428.html