Posted by SLS on September 18, 2006, at 18:56:09
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 18, 2006, at 17:44:45
> > > Here is a good artle. A little lengthy, but it discusses many of the considerations of determining the real effectiveness of antidepressant medications.
> > >
> > > http://www.findarticles.com/p/articles/mi_m1175/is_n5_v28/ai_17382257/pg_1
> > >
> > >
> > > One particular point I liked was that when a survey of the studies involving imipramine were reduced to those which were compared to active placebo (ie placebo with side effects) the active drug margin is almost completely abolished.
> >
> >
> > I don't know what to tell you, Linkadge. I can see right through most of the arguments presented in this article. I find them specious. I am familiar with them, and am also familiar with the material that has proven them wrong,
>
> I guess this means that I am supposed to do exactly that - prove them wrong.
>
> Well, I think maybe I'll do that some time when these authors actually cite the literature they allude to when they make their arguments. I might then be tempted to invest what little energy I have to work with.
>
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> Example: Page 1
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> When I searched Medline, I found only the title of the Kane and Lieberman study they spoke of. They couldn't even bother to provide that. The abstract was not available. "The efficacy of amoxapine, maprotiline, and trazodone in comparison to imipramine and amitriptyline: a review of the literature." First of all, amoxapine, maprotiline, and trazodone had been out for less than a few years and really suck as antidepressants. Then, they have the impudence to say that "When we examined the data..." for themselves, and opine as to their significance. In other words, they say they evaluated the data on their own, and do not refer to the authors' original conclusions!
Well, maybe that's not such a bad idea afterall. That data is there to be scrutinized and evaluated using different statistical techniques and interpreted from different perspectives. Oh, well. I'm just getting too charged up by what I see as specious and deceptive arguments that may pursuade people away from effective treatments. This article is too cleverly written for the layman not to be influenced by it.Some of the concerns raised in this article are addressed in the article below. The issue of the need for active placebos is discussed.
Full text:http://ajp.psychiatryonline.org/cgi/content/full/157/3/327
Validity of Clinical Trials of AntidepressantsFrederic M. Quitkin, M.D., Judith G. Rabkin, Ph.D., Jessica Gerald, B.A., John M. Davis, M.D. and Donald F. Klein, M.D.
ABSTRACT:
OBJECTIVE: Recent reports have criticized the design of antidepressant studies and have questioned their validity. These critics have concluded that antidepressants are no better than placebo treatment and that their illusory superiority depends on methodologically flawed studies and biased clinical evaluations. It has been suggested that the blind in randomized trials is penetrable—since clinician’s guesses exceed chance—and that only active placebo can appropriately camouflage the difference between drug and placebo response. Furthermore, evidence has been cited to suggest that psychotherapy is as effective as antidepressants in both the acute and maintenance treatment of depression. These positions are often accepted as valid and have been broadly discussed in both the lay press and scientific literature. The purpose of this review is to reassess the cited data that support these assertions. METHOD: The authors examined the specific studies that were cited in these reports, evaluated their methodology, and conducted aggregate analyses. RESULTS: Analyses of the original sources failed to substantiate 1) that standard antidepressants are no more effective than placebo, 2) that active placebo offers an advantage over inactive placebo, or 3) that substantial evidence of a medication bias is suggested by raters’ treatment guesses exceeding chance. The authors also note that some researchers have suggested that the interpretation of psychotherapy trials can be complicated by "allegiance effects." CONCLUSIONS: The issue of bias or allegiance effects for both antidepressant and psychotherapy research is real. Investigators of all orientations must guard against potential bias. However, studies cited as supporting the questionable validity of antidepressant trials fail upon closer examination to support assertions that these trials are invalid.
- Scott
poster:SLS
thread:686696
URL: http://www.dr-bob.org/babble/20060909/msgs/687173.html