Psycho-Babble Medication | about biological treatments | Framed
This thread | Show all | Post follow-up | Start new thread | List of forums | Search | FAQ

Re: Most antidepressants are rubbish

Posted by SLS on November 5, 2022, at 23:19:42

In reply to Re: Most antidepressants are rubbish, posted by linkadge on October 31, 2022, at 15:01:52

I failed to make my point clear enough, I guess.

In the 1960s, 1970s, and 1980s, scientists / doctors were just learning that they were looking at a biological phenomenon in the genesis of certain depressive symptomatologies. The syndrome they recognized first was the subtype of Major Depressive Disorder they named endogenous (generated from within). Later, the term melancholic was applied to differentiate this first description from a newly described subtype of depressive disorder to be labelled atypical depression (Which was later found to actually be the more common presentation).

Investigations into this new discovery of the biological underpinnings of mental illness were performed by university psychiatric departments. The studies were funded by universities or the government in the form of grants from the National Institute of Mental Health. These investigators were scientists with very little bias. They were motivated by seeking the answers to medical questions using the scientific method. The ultimate goal was to provide knowledge and understandings that would lead to cures and palliative treatments

By the 1990s, this schema was no longer the model used for scientific investigation. New compounds were investigated using funds provided by the pharmaceutical companies. Their only goal was to bring new compounds to market and make money. The more subjects recruited for the study, the more weight the results were given and the quicker the drug comes to market in order to optimize its patent life. In order to do this, investigator manipulated the inclusion and exclusion criteria. They would take just about anyone who described themselves as being depressed. This effectively diluted the population of subjects by including people who did not have the illness that the drugs were meant to treat. That makes for some pretty bad numbers. The statistical rate of efficacy was necessarily lower. The placebo rate was bound to be higher when people with mild or minor depression or situational depression are accepted into clinical trials. People with minor depression have a higher rate of spontaneous remissions, which is interpreted as a placebo response. In addition, a little recognized variable enters the clinical trial not accounted for when interpreting the numbers measuring the placebo effect. That variable is hope and emotional support. Thus, placebo treatment does not equal no treatment. People with more mild depressions are likely to display a more robust psychological boost. The reported improvement occurs very early in the trial, often by week two. THIS is the placebo effect. It over represents subjects with mild depression more likely to report feeling better.

As we now know, the more severe the depression, the greater the response rate and the lower the placebo rate. The reason for this is simple. In a subject population comprised exclusively of severe presentations, the likelihood of having a high percentage of people with the genuine Major Depressive Disorder is very high. Subjects with low depression scores dont meet the inclusion criteria, thus lowering the rate of placebo response.

Do tricyclics no longer have a 67 percent response rate in 2022 as they did in 1982? How did these drugs become less effective in 30 years? Are people getting better at responding to placebo?

The old days: TCA and SSRI response rates 60-70%
The old days: Placebo response = 25%

Think about it.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




Post a new follow-up

Your message only Include above post

Notify the administrators

They will then review this post with the posting guidelines in mind.

To contact them about something other than this post, please use this form instead.


Start a new thread

Google www
Search options and examples
[amazon] for

This thread | Show all | Post follow-up | Start new thread | FAQ
Psycho-Babble Medication | Framed

poster:SLS thread:1120914