Posted by Jost on September 18, 2006, at 18:57:33
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 18, 2006, at 17:44:45
The points made by Fisher and Greenberg seem useful, in a way-- but the article is from 1995, and one has to remember that they have a point of view, and therefore a bias, just as more biologically-minded psychologists do. They are, for one thing, PhDs-- and that alone means they have an interest (just as MDs do) in the efficacy of their treatment-- ie psychotherapy.
The year 1995 has a lot to do with why they focus so much on older ADs-- which wouldn't be the case with an article today. While it doesn't erase their points, it does diminish their relevance.
The argument about physical effects (ie side effects) that alert patients and researchers to who's taking the placebo and who's taking the "real" drug, for example, is one that researchers have tried to address. As to whether that accounts in some way for the narrowing of the gap between real drug effect and placebo effect or not, I don't know.
The question is: where does one come out?
Take one point they make: 1/3rd of ps respond to placebo, 1/3rd have an AD effect distinct from the placebo effect, and 1/3 have no effect from either placebo or AD.
They conclude that 2/3 have no AD effect. One could conclude that 2/3rd get some positive benefit-- since the placebo effect is a biologically significant effect-- Many of those who improved on the placebo might have done even better if they had had the drug-- because the relative effect of any regimen was not quantified. Indeed, it's very hard to quantify this, although the Star*d study, to its credit, did make relative claims of significance vs. full remission.
The question is where to come out.
Linkadge, you come on in a pessimistic place-- entirely understandably-- No one would argue that depression is understood biologically-- or can be treated reliably by any available drug. SLS and others are more optimistic-- again understandably. The treatments now available are better-- for at least 30% of people-- and more numerous-- perhaps yielding after several drugs are tried, a greater percentage who improve. (As Star*d also gives reason to think.)
They could be better; the varieties, and etiology of depression could (and will) be more fully identified.
This is a stage, perhaps crude, in a history. Now, we're afflicted with doubt and uncertainty, and all the bad side effects and mistaken attempts to treat with drugs that don't work, or don't work all that well.
We need better animal models, fuller exploration of the human and animal genomes, better brain imaging, etc etc. On the whole, it may be more useful to have a certain hopeful skepticism-- but of course, when nothing helps, that's pretty awful, too.
Jost
poster:Jost
thread:686696
URL: http://www.dr-bob.org/babble/20060909/msgs/687174.html