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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Anyuser on February 28, 2002, at 8:01:20
Here is a link to an interesting article about antidepressant drug trials: http://www.brown.edu/Administration/News_Bureau/2001-02/01-091.html
I am continually surprised by how little hard-core science it takes to get a drug approved, and how few people are tested. The number of patients who have taken Celexa, for example, since it was introduced in Europe and then in the US measures in the tens of millions. The number of patients tested in drug trials for Celexa measures in the very low thousands. If you are treated by family physician with, say, a decade of experience treating patients with a particular antidepressant in a clinical setting, that single doctor has probably seen a greater number of depressed patients on that drug, in absolute terms, than all of the patients tested for that drug during trials.
Posted by Bill L on February 28, 2002, at 8:50:00
In reply to Antidepressant drug trials, posted by Anyuser on February 28, 2002, at 8:01:20
You have a very good point! I guess it's just a matter of cost and statistics. Clinical trials are very expensive. Statistically, I guess you figure that a couple of hundred people per trial is "statistically significant".
The other short coming of clinical trials is that each trial only lasts for a very brief period of time such as 6 to 8 weeks. Many people have a different experience with a drug after a year or so then they did after their first 6 weeks on the drug.
> Here is a link to an interesting article about antidepressant drug trials: http://www.brown.edu/Administration/News_Bureau/2001-02/01-091.html
>
> I am continually surprised by how little hard-core science it takes to get a drug approved, and how few people are tested. The number of patients who have taken Celexa, for example, since it was introduced in Europe and then in the US measures in the tens of millions. The number of patients tested in drug trials for Celexa measures in the very low thousands. If you are treated by family physician with, say, a decade of experience treating patients with a particular antidepressant in a clinical setting, that single doctor has probably seen a greater number of depressed patients on that drug, in absolute terms, than all of the patients tested for that drug during trials.
Posted by Bob on February 28, 2002, at 12:58:41
In reply to Re: Antidepressant drug trials, posted by Bill L on February 28, 2002, at 8:50:00
> The other short coming of clinical trials is that each trial only lasts for a very brief period of time such as 6 to 8 weeks. Many people have a different experience with a drug after a year or so then they did after their first 6 weeks on the drug.
==================================================This has always been one of my major beefs. Response in the first 6 weeks of using an AD may (and often is) quite different from response a year down the road. This is why drug companies don't recognize withdrawal syndromes, and why they don't want to face weightgain and poop-out issues. Many of these things happen way after the 6 week period. They are only doing what is necessary to get the drug approved. They have no interest in in running horrifically expensive long term studies in order to find bad news.
Posted by Anyuser on February 28, 2002, at 17:27:32
In reply to Antidepressant drug trials, posted by Anyuser on February 28, 2002, at 8:01:20
I don't approach this matter with any prejudice against the drug companies. I look forward to the day they invent a magic happiness pill, for which they will deserve obscene profits.
My problem has more to do with prejudices about obtaining useful information to make some decisions about my mental health. I think I have imagined a hierarchy of expertise: at the top of hierarchy are the research scientists that concoct these drugs, and at the bottom would be a family physician that writes prescriptions for Prozac. I have had a prejudice, not against the drug scientists, but against that family doctor. I am coming to the realization, duh, that my prejudice was mistaken. A family doctor that has been treating patients with Prozac for a decade knows more, has more information, about Prozac than the researchers that invented it or the FDA scientists that approved it.
The answers to my questions are not to be found in Medline searches.
This is the end of the thread.
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