Posted by larryhoover on December 7, 2013, at 11:51:13
In reply to Re: Irving Kirsch, placebos and antidepressants » larryhoover, posted by doxogenic boy on December 7, 2013, at 5:26:34
> Since I use agomelatine, I don't like the conclusion of this article:
> http://bjp.rcpsych.org/content/203/3/179.abstract?sid=b54ffe6b-dfcb-4716-ac8a-ef15b6a36a38
>
> "We found evidence suggesting that a clinically important difference between agomelatine and placebo in patients with unipolar major depression is unlikely. There was evidence of substantial publication bias."The evidence that they found, and what they conclude about it, are different things.
In the Results section: "Acute treatment with agomelatine was associated with a statistically significant superiority over placebo..."
End of story.
A clinical trial environment is not comparable to real-life treatment. I had a very caring and supportive family physician, who referred me to a very caring and supportive psychiatrist for expert care, but neither one came close to the level of support I received when I participated in a clinical trial. The clinical trial environment exaggerates placebo response, because a lot more goes on besides simply taking a sugar pill.
Here are a couple of earlier threads on that subject. The second one directly addresses the issues I've raised.
http://www.dr-bob.org/babble/20070911/msgs/782723.html
http://www.dr-bob.org/babble/20090104/msgs/873232.html
> Unfortunately, I don't have access to it in full text, but do you think it is likely that their claims are correct? Then it indicates that Servier has fooled the medical authorities in several countries.
Their conclusion is based on a construct of psychological care, which is really a philosophical point, rather than a medical one.
The idea of a "clinically important difference" is not testable. In essence, these authors are giving an opinion, that on a cost/benefit, risk/reward impression, they don't believe that this particular drug is worth using. Even though they confirmed that the drug treatment is better than placebo treatment, including unpublished evidence.
> Here is a full text article:
> http://bjp.rcpsych.org/content/195/3/211.long
>
> "Emotional side-effects of selective serotonin reuptake inhibitors: qualitative study"
>
> They used this method:
> "Qualitative study, gathering data through individual interviews, a group interview and validation interviews; and searching patient websites for relevant posts."
>
> Is this a reliable method for this purpose?
>
> - doxogenicSure, it's an acceptable exercise, but it doesn't really provide anything new. There's no testable hypothesis coming out of it. Some people don't tolerate the effects of their antidepressants, and some of that intolerance has emotional roots.
I had good antidepressant effects on some drugs, but in each successful instance, I also became impotent. That was a deal-breaker for me.
To continue on a drug, or not, is a matter between the patient and his physician.
There are many treatment modalities that don't involve drugs. Drugs are not the solution for everyone. But that does not mean that drug treatment should be withheld, based on a biased reinterpretation of clinical trial data. The clinical trials were never meant to be a representation of real-life treatment.
I have never yet seen one of these critical reviews of clinical trial data that failed to find that drug treatment was significantly superior to placebo. And yet, somehow they come up with rhetoric to suggest that there is no difference. That's politics, not science.
Lar
poster:larryhoover
thread:1052457
URL: http://www.dr-bob.org/babble/20131115/msgs/1055636.html