![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 105. Go back in thread:
Posted by Jimmyboy on September 17, 2006, at 13:26:30
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 17, 2006, at 12:39:46
Hey, I have come to the same conclusion as you Phillipa. I have been on probably 4 diffferent things or more in the past several months and it has just seemed to make the problems worse.. so I am quitting everything also and see how things go. I know that most people would probably think that is a bad idea, but I have been on medicien for 12 years and don;t even know what its like to not be on it.. maybe screwing my my brain chemicals so much is just exacerbating the problems.. I think it is very possible..
But I will say one thing I will stay on is the low dose of Klonopin I take. I trust that , it works and get no side effects, so I think its pretty benign...
But good luck with whatever your decison...
PS- Does anyone else think that, even though there is alot of positive things about this board ( and lots of knowledgeable people - I have learned so much!) That it can kind of be a crutch and remind you constantly that there is something "wrong" with you?? ]Anyway, just my thoughts
JB
Posted by Racer on September 17, 2006, at 13:46:17
In reply to Re: Tonight I don't feel that antidepressants work » SLS, posted by linkadge on September 17, 2006, at 11:33:46
>
>
> I don't think that the 60-70% of people respond stuff is at all acurate.
>Maybe it depends on your definition of "respond?"
My own experience says that it's probably accurate -- about 60 - 70% of people probably do respond to one or another drug. About that number will experience improvement on one or another of the meds on the market.
How many actually experience remission, of course, is a very different question.
I'm sorry none of the drugs you've tried have helped you, Link.
Posted by gardenergirl on September 17, 2006, at 14:10:34
In reply to Tonight I don't feel that antidepressants work, posted by Phillipa on September 16, 2006, at 23:23:47
Phillipa,
Ultimately, it doesn't matter one whit how anyone else did on any medication or combo. All that matters is what works for you. It can be helpful to hear others' experiences, and the information on this site is a valuable set of data to use in your own problem-solving. But it's not the only data, and it can't be generalized into "rules" or absolutes about any drug since we're all unique. I've found it's more effective to look at data from a variety of sources in making decisions.I wonder if you might find it helpful to track your symptoms for awhile to look for patterns. You could track your feelings or overall mood, thoughts, and symptoms, along with other factors such as sleep, diet, exercise, unusual or otherwise interesting events, etc. It doesn't have to be complicated. I've found that doing an exercise like this for a few weeks or a month or so helps me not only to find connections between HOW I'm doing and WHAT I'm doing, and it also helps me be more objective in deciding what's working and what's not.
When I am more depressed, I tend to focus on the negative stuff more and almost "forget" about the postives, so it skews my perspective toward the negative. Having more objective data and seeing it "on paper" counters that.
gg
Posted by Jost on September 17, 2006, at 14:41:39
In reply to Re: Tonight I don't feel that antidepressants work » Phillipa, posted by gardenergirl on September 17, 2006, at 14:10:34
The Star-d study showed that about 50% of people in the study had a remission with an initial antidepressant, either alone or plus a second AD, as a booster, or as a replacement.
They followed people for what?--six months? Someone would have to look back. I might later, if I get more enthusiastic.
Plus that was using only one AD plus a second (the choice for participants was whether to use the second AD as a boost or replacement)-- although of course, there might have been later loss of AD effect--- Remission is a high standard. More than that percentage had significant relief.
Emsam definitely works for me, despite my having tried lots of others, with bad side effects and no helpful effects (or not enough of a helpful effect to justify it).
So, there's reason for hope, and also there are many disappointments for many people along the way.
Jost
Posted by blueberry on September 17, 2006, at 16:32:12
In reply to Tonight I don't feel that antidepressants work, posted by Phillipa on September 16, 2006, at 23:23:47
The brain is very plastic and seems to me to have an extraordinary built-in ability to adjust and reconfigure itself no matter what influence it receives from a drug. For some people it happens fast and others slow, probably from built-in genetic instructions. I think after a while the brain figures out how to compensate for all that extra serotonin from an ssri and then poop-out occurs. And it adjusts to all other drugs too. The dopamine and opioid systems seem particularly sensitive and adjust radidly.
Imagine a virgin undrugged depressed brain. Then it gets under the influence of a drug and then receptors change in density and responsiveness, genes are altered, synapses are altered, and who knows what. Then take away that drug. Now the brain readjusts again, but not back to the original virgin version, as too many solid changes have occured for that to happen. The undrugged brain is now different than it originally was. Now introduce that same drug again, and it is working on a different brain than it was the first time, so it might not work.
Just my wild crazy totally unscientific thoughts on the matter.
I think in rare cases, maybe 10%, antidepressants truly work wonderfully for some magical accidental lucky reason. But for how long? I think the relapse rate for antidepressants is about 100%. It's just a matter of time. I think it is very wise for anyone who experiences a decent drug response to stick with it for the whole ride and don't rock the boat by changing drugs or doses.
And I agree with you...tonight I don't feel like antidepressants work either. The ones that used to work for me are nothing but useless or trouble now.
Posted by jealibeanz on September 17, 2006, at 16:37:09
In reply to Re: Tonight I don't feel that antidepressants work » jealibeanz, posted by Phillipa on September 17, 2006, at 11:35:50
Aren't there some who have done well on EMSAM who also have anxiety?
Posted by linkadge on September 17, 2006, at 16:42:02
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 17, 2006, at 12:39:46
>Man, when I was responding to Parnate + >desipramine for those 9 months, my whole >conscious experience was altered. The world was
>different. It felt different I operated >differently in it. My thoughts and feelings were >changed. My behavior changed. My interactions >with people changed. People reacted differently >towards me. It was a different life. My bowel >functions changed. My sense of taste changed. I >lost my clumsiness. I lost my ataxia while >walking. I regained by ability to read and >comprehend. I began to read newspapers, >magazines, and books for the first time in my >life. My eyesight improved. I no longer felt >cold all the time. My reaction time while >driving improved. I no longer experienced heart >palpitations. I no longer sighed on a regular >basis. I no longer craved carbohydrates and >overate. I no longer overslept. I became >productive and industrious; learning to do >electrical work, carpentry, and autobody, while >reading about the mechanics and history of >quantum physics.Thats what we call bipolar disorer.
Posted by linkadge on September 17, 2006, at 17:00:43
In reply to Re: Tonight I don't feel that antidepressants work, posted by blueberry on September 17, 2006, at 16:32:12
Does anyone have a link to the star*d anyway?
Besides, how many long term studies do we have on these drugs. PEople here keep saying that "all the respoders are out enjoying their lives". But even that is just assumption. We don't really have any clue as to the number of people who have long term remission from these drugs.
Heck, if you make your time frame small enough, you could probably include illegal drugs into the list of substances which could achieve remission.
Its just like that exercise vs. zoloft study. Oh sure, in the first few weeks you can get some impressive effects with an AD. But by the end of the study, the exercise group was doing better.
Drug companies like to make their studies short, because it favors their drug, but long term, who knows.
Long term they just burn you out. You can mess around all you want with the neurotransmitters, but you're still restricted to cellular energy and integrity. You overwork the cell for too long and you run into problems at the level of the mitochondria. We're probably all f'd at the cellular level now. Thats why we're all bipolar, and taking mood stabilizers cause we've overworked the individual cells by forcing them to overwork by bombarding them with ultrabiological levels of neurotransmitter. Sure that might get you over a hump, but then what? Then you're dependant on it just to function normally.
Thats why you hear of people who were never suicidal before taking AD's become suicidal when they decide to quit, because now, the dismal level of neurotransmitter left is not enought to acheive the task at hand. Just like when you quit steroids, your own hormones just don't cut it.
Linkadge
Posted by yxibow on September 17, 2006, at 18:48:52
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 17, 2006, at 17:00:43
> Does anyone have a link to the star*d anyway?
>
It was quite an interesting study
Posted by jealibeanz on September 17, 2006, at 19:31:29
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 17, 2006, at 17:00:43
whoaa... that's really negative! I still have a little hope left for pharmaceuticals.
Posted by Phillipa on September 17, 2006, at 19:54:59
In reply to Re: Tonight I don't feel that antidepressants work, posted by Jost on September 17, 2006, at 14:41:39
Jost are you the only one left doing well on EMSAM? Could you post you're current meds besides that one and side effects? And GG I know stress is the trigger for me. And last night as I read the board I was saddened greatly to see so many people leaving in such a short time. Love Phillipa
Posted by llrrrpp on September 17, 2006, at 20:35:42
In reply to Re: Tonight I don't feel that antidepressants work, posted by Jimmyboy on September 17, 2006, at 13:26:30
Phillipa,
I'm sorry you're having a hard time. I'm having a hard time too. I was feeling great-- got my CES-D from the 50's down to the teens.The medication is helping a lot. I have been able to get my work done, and I have been socializing a lot too. My appetite returned, and I have been sleeping better too.
Until the last few weeks. That's when my T started digging around in my psyche. Things are getting ugly. I am making some connections between my past and my present and my future, and it seems like I can no longer deny that it happened, and that it's a part of me.
Therapy is stirring up all kinds of uncomfortable and devastating feelings and memories. I honestly don't think I would be able to tolerate it if I weren't stable on medication. My pdoc, who is really excellent, has told me several times that the REAL work goes on in therapy; that medication helps make life and therapy tolerable until I learn what is making me sick.
So, I guess I haven't been on this board much lately, because I've been busy doing my work, and freaking out about therapy...
hmm
Hope you all get some relief, and have the presence of mind to document it when you're feeling it. Our memories only remember the bad times when we're down. Enjoy the views at the top of the rollercoaster. Might as well, right?-ll
Posted by rjlockhart on September 17, 2006, at 21:01:30
In reply to Tonight I don't feel that antidepressants work, posted by Phillipa on September 16, 2006, at 23:23:47
But i admit Prozac really doesnt do a danm for me. Ugh just a little mood lift then nothing.I am going through a really miserable time.
Posted by SLS on September 17, 2006, at 23:22:08
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 17, 2006, at 16:42:02
> >Man, when I was responding to Parnate + >desipramine for those 9 months, my whole >conscious experience was altered. The world was
> >different. It felt different I operated >differently in it. My thoughts and feelings were >changed. My behavior changed. My interactions >with people changed. People reacted differently >towards me. It was a different life. My bowel >functions changed. My sense of taste changed. I >lost my clumsiness. I lost my ataxia while >walking. I regained by ability to read and >comprehend. I began to read newspapers, >magazines, and books for the first time in my >life. My eyesight improved. I no longer felt >cold all the time. My reaction time while >driving improved. I no longer experienced heart >palpitations. I no longer sighed on a regular >basis. I no longer craved carbohydrates and >overate. I no longer overslept. I became >productive and industrious; learning to do >electrical work, carpentry, and autobody, while >reading about the mechanics and history of >quantum physics.
>
> Thats what we call bipolar disorer.Yup. Drug-induced only.
The remission that I experienced for 6 months before entering hypomania was normothymic (euthymic). People who are unipolar and respond to antidepressants report similar experiences with similar words. They are also the words used by people who are not depressed to describe life. That's right. I was simply describing life. Many, many people have maintained their remissions for decades. How do I know? I have had close associations with doctors who have treated these people. These have included researchers at the NIMH. The drugs used included MAOIs. I have not heard of a tendency of them to poop-out so soon. That reputation lies solely with the SSRIs. However, all ADs have this potential. They just don't do it so often or so soon.
The options are:
1. Take them.
2. Don't take them.
The advantage to option #2 is that you can do something else.
- Scott
Posted by SLS on September 17, 2006, at 23:34:03
In reply to Cymbalta works for me, posted by llrrrpp on September 17, 2006, at 20:35:42
> Until the last few weeks. That's when my T started digging around in my psyche. Things are getting ugly. I am making some connections between my past and my present and my future, and it seems like I can no longer deny that it happened, and that it's a part of me.
>
> Therapy is stirring up all kinds of uncomfortable and devastating feelings and memories.You will find that you can now process things that you could not have prior to your emergence out of depression. Your brain and mind work better. You have access to memories that you may not have had before. You are more likely to experience emotions now than before. You can think more clearly and more rapidly. Whatever Cymbalta has done biologically, your brain has responded in a manner that leaves you functioning in a way closer to that of other human beings, and you are much more able to do the work in therapy that you have chosen to accomplish.
Check your liver enzymes from time to time.
You knew that.
Good luck.
- Scott
Posted by SLS on September 18, 2006, at 0:02:59
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 17, 2006, at 23:22:08
> > >Man, when I was responding to Parnate + >desipramine for those 9 months, my whole >conscious experience was altered. The world was
> > >different. It felt different I operated >differently in it. My thoughts and feelings were >changed. My behavior changed. My interactions >with people changed. People reacted differently >towards me. It was a different life. My bowel >functions changed. My sense of taste changed. I >lost my clumsiness. I lost my ataxia while >walking. I regained by ability to read and >comprehend. I began to read newspapers, >magazines, and books for the first time in my >life. My eyesight improved. I no longer felt >cold all the time. My reaction time while >driving improved. I no longer experienced heart >palpitations. I no longer sighed on a regular >basis. I no longer craved carbohydrates and >overate. I no longer overslept. I became >productive and industrious; learning to do >electrical work, carpentry, and autobody, while >reading about the mechanics and history of >quantum physics.
> >
> > Thats what we call bipolar disorer.
>
> Yup. Drug-induced only.
>
> The remission that I experienced for 6 months before entering hypomania was normothymic (euthymic). People who are unipolar and respond to antidepressants report similar experiences with similar words. They are also the words used by people who are not depressed to describe life. That's right. I was simply describing life. Many, many people have maintained their remissions for decades. How do I know? I have had close associations with doctors who have treated these people. These have included researchers at the NIMH. The drugs used included MAOIs. I have not heard of a tendency of them to poop-out so soon. That reputation lies solely with the SSRIs. However, all ADs have this potential. They just don't do it so often or so soon.
>
> The options are:
>
> 1. Take them.
>
> 2. Don't take them.
>
>
> The advantage to option #2 is that you can do something else.Of course, you can do something else while doing #1 most of the time.
This is silly. Sorry.
I guess the point is, it is what it is. The drugs are what they are. They are the best that we have at this point, a mere 50 years since their accidental discovery. It is somewhat silly to direct so much anger towards everyone and everything for the shortcomings of the drugs. Blame the drug companies. Blame the doctors. Blame the research institutions. Blame the insurance companies. It's all a conspiracy.
Yeah. Right.
People are doing the right thing, though. Scrutiny. We should be holding our people, places, and things up to public scrutiny, and I am glad that there are people who do. There are conflicts of interest in research projects. There are defects in the design of clinical trials. These things should be looked at and changed if necessary.
But the drugs are what they are.
25 years of investigation into the antidepressants that we use come up with the numbers that I cited. Even if they are optimistic, the lowest numbers one could come up with - placebo - still gives you a 25% shot with each drug. LOL.
Now, some of us are now wanting to believe that the population of posters on Psycho-Babble is representative of the general population? Then where is everybody? There are MILLIONS of depressed people taking antidepressants who know how to surf the Web. Where are they? DUH. They are responding well and consistently to their medication and are not inclined to look for a support group. They do not have questions to be answered. They are not treatment-resistent.
So, we have us. Our drugs don't work on us. Therefore drugs don't work. Therefore drugs don't work on anyone.
Yeah. Right.
- Scott
Posted by linkadge on September 18, 2006, at 7:19:45
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 18, 2006, at 0:02:59
It is all a conspiracy.
The medications negativly affect your ability to process the kinds of things that the medications may be doing to you. Its just like smoking cigarettes. The fact that you get a positive hit every time you smoke a cigarette detracts from the negative thoughts and feelings you may have to the cigarettes.
One cannot form a ballanced opinion about the drugs untill you decide to come off of them. Thats when most people's opinions turn ugly, when it starts to sink in the kinds of effects the drugs may have. Thats when people go really loopy. Sure they're wonder drugs while you're on them.
Linkadge
Posted by llrrrpp on September 18, 2006, at 8:20:47
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 18, 2006, at 7:19:45
Oh, I wanted to add one little thing about AD studies.
Where do they find research subjects who have a diagnosis of Major Depression, with no other concommitant substance abuse issues, psychological, medical or psychiatric disorders?
Maybe the reason why the placebo effect is so high is because these people had fairly simple depressions.
Maybe it's because their brains weren't really that out of whack to begin with.
I mean, depression usually comes with a side order of anxiety, and maybe some substance abuse issues sprinkled on top, an eating disorder, maybe some paranoia, panic, social and personality dysfunctions, and maybe there are other body systems out of whack too- hormones, digestive problems, migraine, metabolism, sleeping disorders, pregnancy, menopause...
Not only are the drugs crude tools, but the "disorder" is poorly conceived. We should treat the whole person. From the synapse level all the way up to the story of their life. Is it any wonder that a pill, or even a combination of pills simply push us from manifesting our problems in one realm (say- depression) to another (say- anxiety) to another (say- infertility)...
-ll
Posted by SLS on September 18, 2006, at 9:36:41
In reply to Re: Tonight I don't feel that antidepressants work » linkadge, posted by llrrrpp on September 18, 2006, at 8:20:47
> Oh, I wanted to add one little thing about AD studies.
>
> Where do they find research subjects who have a diagnosis of Major Depression, with no other concommitant substance abuse issues, psychological, medical or psychiatric disorders?Yes. I believe the inclusion criteria have become wider and wider, and the exclusion criteria perhaps less stringent. The numbers for the same drugs that were tested 20 years ago have changed significantly and demonstrate reduced efficacy with placebo response rates going higher and higher. How can this be? Clinical trials must be examined and redesigned with particular attention payed to the definition of Major Depressive Disorder or Bipolar Disorder, the revison of subject selection criteria, and the scrutinization and standardized of rating scales.
- Scott
Posted by linkadge on September 18, 2006, at 10:46:17
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 18, 2006, at 9:36:41
Here is a good artle. A little lengthy, but it discusses many of the considerations of determining the real effectiveness of antidepressant medications.
http://www.findarticles.com/p/articles/mi_m1175/is_n5_v28/ai_17382257/pg_1
One particular point I liked was that when a survey of the studies involving imipramine were reduced to those which were compared to active placebo (ie placebo with side effects) the active drug margin is almost completely abolished.Linkadge
Posted by linkadge on September 18, 2006, at 10:47:14
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 17, 2006, at 23:22:08
Hey, wait a second. I thought your only one true remssion was with nortryptaline ? ( :) )
Linkadge
Posted by SLS on September 18, 2006, at 16:56:53
In reply to Re: Tonight I don't feel that antidepressants work, posted by linkadge on September 18, 2006, at 10:46:17
> Here is a good artle. A little lengthy, but it discusses many of the considerations of determining the real effectiveness of antidepressant medications.
>
> http://www.findarticles.com/p/articles/mi_m1175/is_n5_v28/ai_17382257/pg_1
>
>
> One particular point I liked was that when a survey of the studies involving imipramine were reduced to those which were compared to active placebo (ie placebo with side effects) the active drug margin is almost completely abolished.
I don't know what to tell you, Linkadge. I can see right through most of the arguments presented in this article. I find them specious. I am familiar with them, and am also familiar with the material that has proven them wrong, one of which I have cited here. I don't know what set these authors off, but they have a conclusion to find evidence for. You know, when it comes down to it, I guess we can both find things in print that are going to support our arguments. But I bet my stuff will stand the test of time.
- Scott
Posted by SLS on September 18, 2006, at 17:44:45
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 18, 2006, at 16:56:53
> > Here is a good artle. A little lengthy, but it discusses many of the considerations of determining the real effectiveness of antidepressant medications.
> >
> > http://www.findarticles.com/p/articles/mi_m1175/is_n5_v28/ai_17382257/pg_1
> >
> >
> > One particular point I liked was that when a survey of the studies involving imipramine were reduced to those which were compared to active placebo (ie placebo with side effects) the active drug margin is almost completely abolished.
>
>
> I don't know what to tell you, Linkadge. I can see right through most of the arguments presented in this article. I find them specious. I am familiar with them, and am also familiar with the material that has proven them wrong,I guess this means that I am supposed to do exactly that - prove them wrong.
Well, I think maybe I'll do that some time when these authors actually cite the literature they allude to when they make their arguments. I might then be tempted to invest what little energy I have to work with.
Example: Page 1When I searched Medline, I found only the title of the Kane and Lieberman study they spoke of. They couldn't even bother to provide that. The abstract was not available. "The efficacy of amoxapine, maprotiline, and trazodone in comparison to imipramine and amitriptyline: a review of the literature." First of all, amoxapine, maprotiline, and trazodone had been out for less than a few years and really suck as antidepressants. Then, they have the impudence to say that "When we examined the data..." for themselves, and opine as to their significance. In other words, they say they evaluated the data on their own, and do not refer to the authors' original conclusions!
Yeah. Right.
- Scott
Posted by SLS on September 18, 2006, at 18:56:09
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 18, 2006, at 17:44:45
> > > Here is a good artle. A little lengthy, but it discusses many of the considerations of determining the real effectiveness of antidepressant medications.
> > >
> > > http://www.findarticles.com/p/articles/mi_m1175/is_n5_v28/ai_17382257/pg_1
> > >
> > >
> > > One particular point I liked was that when a survey of the studies involving imipramine were reduced to those which were compared to active placebo (ie placebo with side effects) the active drug margin is almost completely abolished.
> >
> >
> > I don't know what to tell you, Linkadge. I can see right through most of the arguments presented in this article. I find them specious. I am familiar with them, and am also familiar with the material that has proven them wrong,
>
> I guess this means that I am supposed to do exactly that - prove them wrong.
>
> Well, I think maybe I'll do that some time when these authors actually cite the literature they allude to when they make their arguments. I might then be tempted to invest what little energy I have to work with.
>
>
> Example: Page 1
>
> When I searched Medline, I found only the title of the Kane and Lieberman study they spoke of. They couldn't even bother to provide that. The abstract was not available. "The efficacy of amoxapine, maprotiline, and trazodone in comparison to imipramine and amitriptyline: a review of the literature." First of all, amoxapine, maprotiline, and trazodone had been out for less than a few years and really suck as antidepressants. Then, they have the impudence to say that "When we examined the data..." for themselves, and opine as to their significance. In other words, they say they evaluated the data on their own, and do not refer to the authors' original conclusions!
Well, maybe that's not such a bad idea afterall. That data is there to be scrutinized and evaluated using different statistical techniques and interpreted from different perspectives. Oh, well. I'm just getting too charged up by what I see as specious and deceptive arguments that may pursuade people away from effective treatments. This article is too cleverly written for the layman not to be influenced by it.Some of the concerns raised in this article are addressed in the article below. The issue of the need for active placebos is discussed.
Full text:http://ajp.psychiatryonline.org/cgi/content/full/157/3/327
Validity of Clinical Trials of AntidepressantsFrederic M. Quitkin, M.D., Judith G. Rabkin, Ph.D., Jessica Gerald, B.A., John M. Davis, M.D. and Donald F. Klein, M.D.
ABSTRACT:
OBJECTIVE: Recent reports have criticized the design of antidepressant studies and have questioned their validity. These critics have concluded that antidepressants are no better than placebo treatment and that their illusory superiority depends on methodologically flawed studies and biased clinical evaluations. It has been suggested that the blind in randomized trials is penetrable—since clinician’s guesses exceed chance—and that only active placebo can appropriately camouflage the difference between drug and placebo response. Furthermore, evidence has been cited to suggest that psychotherapy is as effective as antidepressants in both the acute and maintenance treatment of depression. These positions are often accepted as valid and have been broadly discussed in both the lay press and scientific literature. The purpose of this review is to reassess the cited data that support these assertions. METHOD: The authors examined the specific studies that were cited in these reports, evaluated their methodology, and conducted aggregate analyses. RESULTS: Analyses of the original sources failed to substantiate 1) that standard antidepressants are no more effective than placebo, 2) that active placebo offers an advantage over inactive placebo, or 3) that substantial evidence of a medication bias is suggested by raters’ treatment guesses exceeding chance. The authors also note that some researchers have suggested that the interpretation of psychotherapy trials can be complicated by "allegiance effects." CONCLUSIONS: The issue of bias or allegiance effects for both antidepressant and psychotherapy research is real. Investigators of all orientations must guard against potential bias. However, studies cited as supporting the questionable validity of antidepressant trials fail upon closer examination to support assertions that these trials are invalid.
- Scott
Posted by Jost on September 18, 2006, at 18:57:33
In reply to Re: Tonight I don't feel that antidepressants work, posted by SLS on September 18, 2006, at 17:44:45
The points made by Fisher and Greenberg seem useful, in a way-- but the article is from 1995, and one has to remember that they have a point of view, and therefore a bias, just as more biologically-minded psychologists do. They are, for one thing, PhDs-- and that alone means they have an interest (just as MDs do) in the efficacy of their treatment-- ie psychotherapy.
The year 1995 has a lot to do with why they focus so much on older ADs-- which wouldn't be the case with an article today. While it doesn't erase their points, it does diminish their relevance.
The argument about physical effects (ie side effects) that alert patients and researchers to who's taking the placebo and who's taking the "real" drug, for example, is one that researchers have tried to address. As to whether that accounts in some way for the narrowing of the gap between real drug effect and placebo effect or not, I don't know.
The question is: where does one come out?
Take one point they make: 1/3rd of ps respond to placebo, 1/3rd have an AD effect distinct from the placebo effect, and 1/3 have no effect from either placebo or AD.
They conclude that 2/3 have no AD effect. One could conclude that 2/3rd get some positive benefit-- since the placebo effect is a biologically significant effect-- Many of those who improved on the placebo might have done even better if they had had the drug-- because the relative effect of any regimen was not quantified. Indeed, it's very hard to quantify this, although the Star*d study, to its credit, did make relative claims of significance vs. full remission.
The question is where to come out.
Linkadge, you come on in a pessimistic place-- entirely understandably-- No one would argue that depression is understood biologically-- or can be treated reliably by any available drug. SLS and others are more optimistic-- again understandably. The treatments now available are better-- for at least 30% of people-- and more numerous-- perhaps yielding after several drugs are tried, a greater percentage who improve. (As Star*d also gives reason to think.)
They could be better; the varieties, and etiology of depression could (and will) be more fully identified.
This is a stage, perhaps crude, in a history. Now, we're afflicted with doubt and uncertainty, and all the bad side effects and mistaken attempts to treat with drugs that don't work, or don't work all that well.
We need better animal models, fuller exploration of the human and animal genomes, better brain imaging, etc etc. On the whole, it may be more useful to have a certain hopeful skepticism-- but of course, when nothing helps, that's pretty awful, too.
Jost
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