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Dr. Bob is Robert Hsiung, MD,
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Posted by fuzz54 on September 14, 2007, at 12:17:46
In reply to Re: News - Antidepressants Vindicated?, posted by linkadge on September 9, 2007, at 12:21:58
> >Anti-depressants work for many depressed people. >Thus anti-depressants reduce the risk of suicide.
>
> Placebos work for many people too.
>
> LinkadgeI was told by my therapist (who is now a doctor doing psych research) that the placebo effect can be very real in the short-term but loses its effectiveness over the long-term. Anyone ever see any studies on this?
As for SSRIs being compared to placebos in effectiveness, I've been on some SSRIs that did nothing for me and some that helped quite a bit. I didn't have any special knowledge that made me expect some SSRIs to work and some to not work. For my specific case this leads me to conclude that SSRIs work better than placebo, however I am willing to concede that there are many factors at work in determining if someone will respond to an SSRI better than placebo. Maybe I'm just lucky.
fuzz
Posted by linkadge on September 14, 2007, at 13:59:12
In reply to Re: STAR*D study, 33% sucess with first AD-sam123 » linkadge, posted by Larry Hoover on September 14, 2007, at 8:52:21
>What troubles you about it?
No placebo arm.
Thats what little there is left to keep serious dogma in check.
Linkadge
Posted by linkadge on September 14, 2007, at 14:12:54
In reply to Re: placebo vs. antidepressant, posted by rskontos on September 14, 2007, at 11:05:17
Placebos aren't the only things to loose effectiveness over time.
Antidepressant "poop out" is being studied more and more.
Thats probably the biggest complaint we have here: "such and such a drug worked, and now it no longer works".
Tollerance to a pharmachological effect is one possability, loss of placebo effect is another.
Linkadge
Posted by sam123 on September 14, 2007, at 14:16:48
In reply to Re: placebo vs. antidepressant, posted by linkadge on September 14, 2007, at 14:12:54
> Placebos aren't the only things to loose effectiveness over time.
>
> Antidepressant "poop out" is being studied more and more.
>
> Thats probably the biggest complaint we have here: "such and such a drug worked, and now it no longer works".
>
> Tollerance to a pharmachological effect is one possability, loss of placebo effect is another.
>
> Linkadge
In the 20+ yrs I have been taking AD's I pooped out twice, and then found another med or combo that works just as well. I seem to poop out around the 10 yr mark.
Posted by linkadge on September 14, 2007, at 14:24:56
In reply to Re: News - Antidepressants Vindicated? » linkadge, posted by fuzz54 on September 14, 2007, at 12:17:46
>I was told by my therapist (who is now a doctor >doing psych research) that the placebo effect >can be very real in the short-term but loses its >effectiveness over the long-term. Anyone ever >see any studies on this?
This is kind of an unsubstantiated argument.
The bulk of antidepressant data is on trials that are done for such a short period of time. The drug company only needs to show that a drug is better than placebo for a number of weeks. How then do we really know if antidepressants outperform placebo in the long run? How do we even know that antidepressants "work" in the long run? We don't. There is a severe lack of good long term trial data.
The statment "only the true antidepressant effect will stand the test of time", can be used any way you like!
For instance, when an antidepressant poops out, some would argue (conviently) that there was no "true" responce to begin with so there really can be no "poop out". Ie, it is possable to have a placebo responce to an active drug.
Then its kind of a free for all.
Linkadge
Posted by linkadge on September 14, 2007, at 14:29:33
In reply to Re: placebo vs. antidepressant, posted by sam123 on September 14, 2007, at 14:16:48
>In the 20+ yrs I have been taking AD's I pooped >out twice, and then found another med or combo >that works just as well. I seem to poop out >around the 10 yr mark.
There are other possabilities. You may have just been well for a period of time while you were taking a particular drug, and that you got sick again around the 10 year mark.
Linkadge
Posted by sam123 on September 14, 2007, at 14:38:31
In reply to Re: placebo vs. antidepressant, posted by linkadge on September 14, 2007, at 14:29:33
>
> There are other possabilities. You may have just been well for a period of time while you were taking a particular drug, and that you got sick again around the 10 year mark.
>
> Linkadge
>You can always explain away anything but the only remissions I have experienced were med induced.
Far too many PITA HMO's that made me go without meds for a period; I crash quite quickly.
Posted by rskontos on September 14, 2007, at 15:23:54
In reply to Re: placebo vs. antidepressant, posted by sam123 on September 14, 2007, at 14:38:31
OK, assuming they didn't work then would there be any withdrawals from the drugs. Can you concluded that the drug is working if when you withdraw from it there are withdrawals or is that a different can of worms?
Posted by sam123 on September 14, 2007, at 15:39:41
In reply to Re: placebo vs. antidepressant, posted by rskontos on September 14, 2007, at 15:23:54
I do have problems with withdrawls, never have, Effexor gave me some discomfort for a day at best.
I was on Effexor for 10 yr, I did not have problems when I missed a dose.
Posted by ttee on September 14, 2007, at 19:00:59
In reply to Re: News - Antidepressants Vindicated? » fuzz54, posted by linkadge on September 14, 2007, at 14:24:56
Link - Didn't they do longer term (12 months) studies on Effexor, and Emsam? I thought that they ran the studies out 12 months and randomized the active group with placebos to see if they relapsed.
> >I was told by my therapist (who is now a doctor >doing psych research) that the placebo effect >can be very real in the short-term but loses its >effectiveness over the long-term. Anyone ever >see any studies on this?
>
> This is kind of an unsubstantiated argument.
>
> The bulk of antidepressant data is on trials that are done for such a short period of time. The drug company only needs to show that a drug is better than placebo for a number of weeks. How then do we really know if antidepressants outperform placebo in the long run? How do we even know that antidepressants "work" in the long run? We don't. There is a severe lack of good long term trial data.
>
> The statment "only the true antidepressant effect will stand the test of time", can be used any way you like!
>
> For instance, when an antidepressant poops out, some would argue (conviently) that there was no "true" responce to begin with so there really can be no "poop out". Ie, it is possable to have a placebo responce to an active drug.
>
> Then its kind of a free for all.
>
> Linkadge
>
>
>
>
>
Posted by jhj on September 15, 2007, at 2:17:03
In reply to Re: placebo vs. antidepressant, posted by linkadge on September 14, 2007, at 14:29:33
"There are other possabilities. You may have just been well for a period of time while you were taking a particular drug, and that you got sick again around the 10 year mark.Linkadge"
Fantastic argument.You seem to have some deep rooted problems against pharma companies working in the field of antidepressants.It is a challenge to those posters' intelligence who say they have benefited from antidepressants to say that they all have improved because of faith in treatment and not due to antidepressant effect of meds.When 7 out of 10 people come and say that they have improved after taking antidepressants i think it is better to believe them rather then getting obsessed about "placebo arm".And also you are implying throughout the thread that the studies,articles and sites quoted by you are "decent" and "unbiased" and those quoted by others are biased.Anyway,i request you to keep on arguing because it is providing uninterrpted entertainment though probably this site is not meant for that.I admire it because i know you arguing to make depressed people to have some fun and you are not serious at all.Am i right?
Posted by linkadge on September 15, 2007, at 8:21:45
In reply to Re: placebo vs. antidepressant, posted by rskontos on September 14, 2007, at 15:23:54
You can have withdrawl from a caffiene, that doesn't mean it was affecting your depression.
Linkadge
Posted by linkadge on September 15, 2007, at 8:23:49
In reply to Re: News - Antidepressants Vindicated?, posted by ttee on September 14, 2007, at 19:00:59
Yes, I think there are a limited number of long term trials on venlafaxine. I *personally* think those studies would be highly biased.
Setting up an expensive short term trial that fails is one thing.
In addition, we simply need *more* of them.
Linkadge
Posted by linkadge on September 15, 2007, at 8:27:56
In reply to Re: placebo vs. antidepressant, posted by jhj on September 15, 2007, at 2:17:03
>You seem to have some deep rooted problems >against pharma companies working in the field of >antidepressants.
Nothing of the sort. I am just posing possabilities that some researchers have sugested.
>It is a challenge to those posters' intelligence >who say they have benefited from antidepressants >to say that they all have improved because of >faith in treatment and not due to antidepressant >effect of meds.
That is incorrect too. The placebo effect has been studied intensivly. It is not a product of unintellegence.
>When 7 out of 10 people come and say that they >have improved after taking antidepressants i >think it is better to believe them rather then >getting obsessed about "placebo arm".
I disagree. If 7 out of 10 people had correspondingly responded to a placebo in the same study, then the presence of the placebo arm is highly meaninful, and indispensable.
I can only agree with the line of logic "as long as the patient is happy thats all that matters" so much.
Linkadge
Posted by Larry Hoover on September 15, 2007, at 9:50:20
In reply to Re: News - Antidepressants Vindicated? » linkadge, posted by fuzz54 on September 14, 2007, at 12:17:46
> > >Anti-depressants work for many depressed people. >Thus anti-depressants reduce the risk of suicide.
> >
> > Placebos work for many people too.
> >
> > Linkadge
>
> I was told by my therapist (who is now a doctor doing psych research) that the placebo effect can be very real in the short-term but loses its effectiveness over the long-term. Anyone ever see any studies on this?If someone could get a full-text of this article, we might have the evidence laid bare:
J Clin Psychopharmacol. 2007 Apr;27(2):177-81.
Impact of study design on the results of continuation studies of antidepressants.
Zimmerman M, Posternak MA, Ruggero CJ.
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA. mzimmerman@lifespan.orgAntidepressant continuation studies have used 2 different designs. In the placebo substitution design, all patients are initially treated with active medication in an open-label fashion, and then treatment responders are randomized to continue with medication or switch to placebo in a double-blind manner. In the extension design, patients are randomized to a double-blind placebo-controlled acute study at the outset, and responders to active treatment and placebo are continued on the treatment to which they initially responded. We hypothesized that the design of antidepressant continuation studies would impact on the likelihood of relapse. In the extension design, there is no change in treatment. Whether patients responded to placebo or medication, the treatment that produced the response is continued. In contrast, in the placebo substitution design, there is an obvious change in treatment protocol upon initiation of the continuation phase. Patients are aware that they initially received active medication, and there is now a chance that they will be switched to placebo. We speculated that the expectation of a continued positive response is lower in patients treated using the placebo substitution design than the extension design and therefore predicted that relapse rates would be higher. We conducted a meta-analysis of antidepressant continuation studies and compared the relapse rates in continuation studies using these 2 different designs. As predicted, for both the active medication and placebo groups, the frequency of relapse was lower in studies using an extension design. We also found that the difference in relapse risk between antidepressants and placebo was greater with the extension design. Thus, the design of continuation studies of antidepressants was associated with the absolute percentage of patients who relapse on both active medication and placebo, as well as estimates of differential relapse risk between antidepressants and placebo.
Posted by jhj on September 16, 2007, at 2:04:56
In reply to Re: News - Antidepressants Vindicated? » ttee, posted by linkadge on September 15, 2007, at 8:23:49
In addition, we simply need *more* of them.
Why do you want to have more long term studies of venlafaxine or any other ADs when facts have establish according to you that placebo work as well as antidepressant? Why should people waste money,time and their energy by conducting more long term trials when it is already known that venlafaxine is no better then placebo?
Posted by jhj on September 16, 2007, at 2:17:49
In reply to Re: placebo vs. antidepressant » jhj, posted by linkadge on September 15, 2007, at 8:27:56
It is not a product of unintellegence.
I am not suggesting you are saying any unintelligent thing.i am saying that you think those posters who claim that they have benefited by use of Antidepresants are naive and unintelligent You are saying 7 out of 10 people who say they have improved despite being given only dummy pill can be misled easily.So,i think i should assume fake identity of a psychiatrist and start distributing dummy pills to patients of depression and i can be as successful as qualified pdoctors because the improvement reported by their patient would not be better then those of mine.In fact,with claver and shrewd publicity i can be more successful then qualified psychiatrists by augmenting the effect of faith in medicines with faith in my ability too as psychiatrist and i would be able to give better results then many of them.
I *personally* think those studies would be highly biased.
You always *personally* think that those sites,links,articles and studies quoted which go against your point of view are highly biased and those supporting your view point are decent and unbiased.I am not saying you are saying anything illogical.I am merely saying that my level is not high enough to understand the logic.
Posted by Tennisplayer on September 16, 2007, at 6:44:09
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:54:25
Posted by blueboy on September 16, 2007, at 10:43:43
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
The whole "SSRI's cause teen suicide" hysteria seemed to me to be junk science.
I had a pdoc, an old guy with a lot of experience, tell me once that the primary risk of suicide came not at the bottom of a major depressive episode, but when the person began to improve; the pain and period of suicidal ideation may be present during the worst of a depressive episode, but the physical act requires positive activity.
In other words, some people get so depressed that they can't even kill themselves. You could say, they don't have enough energy.
I always wondered why this explanation wasn't at least advanced and explored in connection with suicide and early use of SSRI's. This is just more idiot "post hoc ergo prompter hoc" nonsense.
Kid takes pill, kid commits suicide, therefore the pill "caused" the suicide. Pffft.
I would certainly keep careful watch over anyone with massive depression who starts a potentially effective treatment.
Posted by Deputy 10derheart on September 16, 2007, at 12:35:51
In reply to Re: placebo vs. antidepressant-linkadge, posted by jhj on September 16, 2007, at 2:17:49
> i am saying that you think those posters who claim that they have benefited by use of Antidepresants are naive and unintelligent
> You always *personally* think that those sites,links,articles and studies quoted which go against your point of view are highly biased and those supporting your view point are decent and unbiased.
>You seem to have some deep rooted problems against pharma companies
>i think it is better to believe them rather then getting obsessed about "placebo arm".
>Anyway,i request you to keep on arguing because it is providing uninterrpted entertainmentPlease don't post anything that might lead others to feel accused or put down, jump to conclusions about others or be sarcastic. I want to bring to your attention that this is your third warning in the past month, therefore, future violations are quite likely to result in a block. Please consider reviewing the FAQ on civility rules at Babble, particularly the use of "I" statements, or finding a civility buddy to review your posts prior to submitting them to the board.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
--10derHeart, acting as deputy for Dr. Bob
Posted by linkadge on September 16, 2007, at 21:26:06
In reply to Re: placebo vs. antidepressant-linkadge, posted by jhj on September 16, 2007, at 2:17:49
>I am not suggesting you are saying any >unintelligent thing.
I never suggested you were. I was simply suggesting that one needn't be unintelligent to experience a placebo effect.
>i am saying that you think those posters who >claim that they have benefited by use of >Antidepresants are naive and unintelligent.
Again, thats not what I said. I am saying that smart people can experience a placebo effect, and that responce to a placebo is independant of intellegence.
>You are saying 7 out of 10 people who say they >have improved despite being given only dummy >pill can be misled easily.I am saying that in a good portion of clinical trials placebo responce matches active drug responce, and that those who have studied placebo effect in depth have concluded that there is no general relationship between susceptability to placebo effect and intellegence or lack thereof.
>So,i think i should assume fake identity of a >psychiatrist and start distributing dummy pills >to patients of depression and i can be as >successful as qualified pdoctors because the >improvement reported by their patient would not >be better then those of mine.
I didn't say that, but I would contend to the notion that if doctors started to dispence active placebos that their patients would experience roughly the same rate of responce as if their patients were given active drugs. I also believe that the sum of clinical trial data (were it fully available) would probably support that view.
>You always *personally* think that those >sites,links,articles and studies quoted which go >against your point of view are highly biased and >those supporting your view point are decent and >unbiased.
If you say so.
>I am not saying you are saying anything >illogical.I am merely saying that my level is >not high enough to understand the logic.
Well for starters, if my points were complete nonsense then this threat would not have lasted this long. There are a considerable number of holes to conventional theories and the accompanying support of the modern day "well wishing" drug company.
It am not trying to necessarily prove a point as much as I am going to pose counterexamples to certain ideas.
Linkadge
Posted by linkadge on September 16, 2007, at 21:28:51
In reply to Re: News - Antidepressants Vindicated?, posted by jhj on September 16, 2007, at 2:04:56
>Why do you want to have more long term studies >of venlafaxine or any other ADs when facts have >establish according to you that placebo work as >well as antidepressant? Why should people waste >money,time and their energy by conducting more >long term trials when it is already known that >venlafaxine is no better then placebo?
The more clinical trials the better. I am not against the possability that certain drugs may vindicate themselves, or that certain drugs will one day provide a more definively clear and consistent superiority to placebo.
Linkadge
Posted by linkadge on September 16, 2007, at 21:46:57
In reply to Re: News - Antidepressants Vindicated?, posted by blueboy on September 16, 2007, at 10:43:43
>I had a pdoc, an old guy with a lot of >experience, tell me once that the primary risk >of suicide came not at the bottom of a major >depressive episode, but when the person began to >improve; the pain and period of suicidal >ideation may be present during the worst of a >depressive episode, but the physical act >requires positive activity.
You need to look at exactly who is forming such an opinion. If antidepressants are given a black box warning, psychiatrists take a big hit.
It is psychiaty's best wepon to blame the patient. In the opinion of psychiatry, the drugs are never to blame.
If a drug causes suicidal ideation, its not the drug, its the patient, the drug simply gave the patient energy.
If a drug causes sexual dysfunction its not the drug, its the patients depression causing sexual dysfunction.
If a drug causes mania, its not the drug, its the patient who has latent bipolar disorder.
The notion that antidepressnats increase the risk of suicide only in that they give the patient "energy" is only a convenient theory that exonerates antidepressants from the possability that they actually *can* alter brain chemistry enough to push somebody over the edge.
Even Larry Hoover states that he had a psychotic reaction to Luvox. I wouldn't try and suggest that he had latent psychosis that the drug merely brought out, I would agree that the state was drug induced.
Now imagine that he wasn't a fully grown adult. Imagine he was being told that everything was fine. Kids don't always have the sensability to distinguish between drug induced effects and a natural feeling.
I personally had certain SSRI's induce active suicidiality. Ie before I took the drug I was just depressed but not suicidal, but when I started the drug, I became actively suicidal.
My experience is not proof of anything, but just my experience however.
>In other words, some people get so depressed >that they can't even kill themselves. You could >say, they don't have enough energy.
I just don't buy that theory. The "energy" it takes to swallow a bunch of pills is insignificant.
>Kid takes pill, kid commits suicide, therefore >the pill "caused" the suicide. Pffft.
I wouldn't shug off the possability so easily. It could be be a terrable mistake.
>I would certainly keep careful watch over anyone >with massive depression who starts a potentially >effective treatment.
I would peronally keep carefull watch over anybody who takes drugs that can massivly alter brain chemistry in a short period of time.
Linkadge
Posted by Phillipa on September 16, 2007, at 22:42:09
In reply to Re: News - Antidepressants Vindicated? » blueboy, posted by linkadge on September 16, 2007, at 21:46:57
Link everything you say is true in my opinion related to myself. Whenever I change some doc or med for a few days I feel much better then it goes downhill. Knowing my suggestibility I bet a placebo would work for me very well. A wierd example is before I was sick and working I still had anxiety but cause I knew working 3-ll all my days work was done had excercised and what not I could drink a pot of coffee and go home and go right to sleep. Today since last time my thyroid really went skyhigh with anxiety I had had a starbucks iced coffee 9 years ago and today I see one want one and am so afraid I know I'd have a panic attack from the memory. Depression is the same way. And I don't get how something in the beginning can make you anxious and take away your anxiety. Maybe it the med kills brain cells? Is this too farfetched. I think of these things all the time. As I have no idea. Phillipa I also think of lar's psychotic episode to luvox and psychologically maybe that is one of the reasons I don't go higher as I know how informed he is.Or another Starbucks. I know all people are different. When in nursing school the instructors at the end of school proud of being magna cum laude said I constantly challenged them as I asked so many questions and lots of times they had to go look up the answers. Enough from my thinking out loud.
Posted by rskontos on September 17, 2007, at 10:47:58
In reply to Re: News - Antidepressants Vindicated? » linkadge, posted by Phillipa on September 16, 2007, at 22:42:09
Link I too agree, I had suicidal thoughts on cymbalta and until then I was just extremely depressed not suicidal. I had panic attacks, gad, but no suicide until I that pill. Too say it brought it brought out latent thoughts would be laughable because in my right mind, whatever that is, I would never have considered it as I have two children that I would never subject that too. I can truly say it was the drug. Since being off, I have been depressed and all the other things but no suicidal thoughts; only while tapering did I have thoughts of suicide. It was the drug not me. It altered me in ways that today surprised me. I understand why the p-docs and the pharm companies say what they say but we know from our experience it isnt' always the case. Maybe sometimes they are right, I don't know, I just know in my case they would be wrong.
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