Posted by linkadge on January 5, 2008, at 19:53:31
In reply to Re: STAR*D confirmed what patients already knew » linkadge, posted by Racer on January 5, 2008, at 18:27:25
>That is the purpose of this study, and the >methodology used seems appropriate to me for >that purpose. This was not a study of the >placebo response in depression treatment.
It doesn't matter how it was designed. In the end, people need to ask themselves if they want the results to have meaning, or to be meaningless. Even if you are designing a study to determine what is the optimal choice for treatment, without a placebo arm one doesn't really know if that 'optimal' strategy is infact optimal or just the product of chance. Only when results outperform those of the placebo do they have meaning.
If, for instanse, a drug algorithm fails to outperform placebo, then if could simply be that the chosen algorighm was the one that produced the fewest side effects.
>That non-response may be a question of >inadequate dosing in some (or even many) cases. >As far as I'm concerned, that's something good >to know.
I personally didn't get that as a strong impression from the results I read.
>As for the basic premise that response to >antidepressants is no better than response to >placebo, I'm going to argue that.
I don't care.
>First, as Dinah said, most of us can point to >effects of these medications.
Placebos with a buzz.
>Many of those effects do mitigate our symptoms, >even if they do not "cure" the disorder or even >result in complete remission.
Placebos mitigate too. That is the premise of the placebo effect, that one part of the brain can override another.
>Still, if the effects of the medication affect >our symptoms, isn't that response to the >medication? Or do you still consider that to be >a placebo response because it may not have >resulted in complete remission?
A placebo response is one that would have occured if the same patient was given a placebo.
>It is your stated opinion that anti-depressants >are no more effective than placebo.
My stated opinion is based on fact. That more than half of all published clinical trials on SSRI and newer antidepressants fail to show superiority of the active drug over the placebo. Take that fact as you will.
>In the opinions of others, however, >antidepressant medications are more effective >than placebo.
For some, thats the only way they will work.
>In the real world, though, most of us don't care >if 30% or 70% of the participants in a research >study responded to a particular drug: we're >looking for a 100% response rate with an n of 1. >Do *I* respond to a particular medication? >That's quite a different question, don't you >agree?I agree that in the end a response is a response. However, in understanding the way that depression works, it is critical to have a good idea of what gets people better. You can't just believe in anything, you need to believe in something that is established, something that you believe will work. People enter the system with the wrong assumptions IMHO.
>Frankly, I'd be inclined to cheer that anyone >has done a real world style study of the way >depression is treated, if only because it's a >nice relief from the usual sort of short term >study one usually sees. Is this particular study >perfect? I don't think so, because I don't think >it's possible to create a perfect study when >you're dealing with the diversity of the >population being studied. For that matter, I'm >not sure what sort of study could be done >perfectly in anything involving any living >creature, just because of the diversity involved.
The more studies the better. I am not against studies, I just believe that its important to get a good idea of what a result means and what it doesn't mean. In the end, it is good that people can recover, I just hate to see people become institutionalized by psychiatry (not in the literal sense).
>And then maybe we can look at STAR*D and >say, "wow, someone finally did a study into >treatment algorithms for depression that more >accurately reflected real world treatment." >Regardless of one's opinion regarding the >efficacy of placebos in the treatment of >depression, or one's opinion regarding the >uselessness of antidepressant medication for the >treatment of depression, isn't it nice that >someone did study the outcomes in a longer term >design, with emphasis on what to do next if the >first choice didn't work?
I think it is necessary to continually challenge the fundimental assumptions psychiatry makes. You have to get past level a. before you can go on to level b. If we can't statistically beat the placebo, then all else is meaningless. Such studies don't answer real world questions because they are not starting with real world assumptions.
Don't you see, it doesn't matter if effexor/remeron beats parnate if both are worse than placebo.
Linkadge
poster:linkadge
thread:804126
URL: http://www.dr-bob.org/babble/20080105/msgs/804525.html