![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 116. Go back in thread:
Posted by bulldog2 on April 16, 2008, at 14:58:45
In reply to They just don't work. FACT., posted by Betula on April 16, 2008, at 11:51:18
> > SSRIs make people apathetic. This enables people to be indifferent towards depressive thoughts and angst. Emotional flatness might be a good thing for some people, but the fact is that some people are better off without this. Sexual side effects and weight gain aren't exactly mood-elevating, either.
> >
> > The truth can be demoralizing, but there's no reason to give people false hopes.
>
> I agree with every word you say anti-serial.
>
> If anti-depressants work, then why are they so many people on this board for whom they fail?
>
> Everyone knows that, for example, paracetamol is effective against high fevers for nearly everyone.
>
> Why don't we think that SSRIs are that effective? Everyone accepts that sometimes SSRIs work, sometimes they don't. Therefore, they are not that effective for depression, as paracetamol is for high fevers.
>
> And actually, there have been quite a few studies which show that SSRIs are often no more effective than placebo. That is a fact.
>
> May I refer disbelievers (and believers for that matter) to this popular news article, talking about the orginal research:
>
> http://news.bbc.co.uk/2/hi/health/7263494.stm
>
> I think what makes this study particulary accurate is the fact that:
>
> -they reviewed data on 47 clinical trials.
>
> -they reviewed published clinical trial data, and unpublished data secured under Freedom of Information legislation.
>
> This means that they also included the unfavourable studies that the big pharmacetical companies DO NOT publish because it shows their drugs in a bad light. AFAIK, it is not possible to obtain this data in the USA.
>
> So there you have it. Antidepressants have little use, FACT.
>
>You seem to use the term ssri and ad as if they are one. There are many classes of ads and many treatment options.
The fact that so many people come to this board ...how many people come to this board in relationship to the total population of people with emotional disorders? Probably far less than
1 % if that.
Even on this board there are successes and failures.
Why does everything have to be so black or white.Meds help some and some do not respond and some may not even need them
But why take away the hope of people who are suffering? Their own trials will tell them if meds work.
Posted by SLS on April 16, 2008, at 15:42:45
In reply to Re: They just don't work. FACT., posted by Betula on April 16, 2008, at 14:53:16
> Hey, great that the drugs work for you. Super!
Thanks. It took 25 years to get it right!
Who cares how you get well, Betula? Just do it. I'll throw up a prayer for you.
I would be extraordinarily happy to see you get well, however you make it happen. Hell, if I were told that I would get well drinking horse piss, I would (gulp)... Well, maybe not.
I would encourage you to continue to search for literature that affirms and those that refute the question of how effective antidepressants really are - especially in drug-combination treatments. I hope you can convince yourself that among these various drugs you will find your magic pills. I am convinced that they exist. I came to this conclusion in 1982 when they first worked for me. I find the medical and popular literature quite persuasive in demonstrating to me that treatment can be effective in at least 85% of people. I wish it were 100%. One day...
Good luck.
- Scott
Posted by Betula on April 17, 2008, at 9:13:07
In reply to Re: They just don't work. FACT. - Who cares? :-) » Betula, posted by SLS on April 16, 2008, at 15:42:45
Sure, I could find magic pills that would relieve me of my OCD/anxiety/depression, but they would just mask the underlying cause. The depression etc would return once I quit the pills. And this I know because I've been down that route.
I do not think it is healthy to take these pills indefinately. I view them as short term band aids to help you get through tough periods. That is all. I do not think they were even designed to be taken for extended periods of time, or at least, certainly the SSRIs weren't. And I certainly do not want to be one of those ones who become addicted for life or have terrible discontinuation sydromes. And let us not forget they haven't been around for all that long - who knows what happens to you if you take Effexor (yes, I know not technically an SSRI, but the same principles apply) for 20 years and try to wean off?? The drug companies sure as hell don't know. I am really not convinced we know enough about SSRIs to really say for sure. And let us not forget the pharma companies hiding information about the increased risk of suicide. Even if they didn't hide it, at least this is something unpredicted to come out of these drugs. Who knows what'll happen with say, 25+ years of use of lexapro? No-one simply knows for sure.
Actually, for me, therapy is proving to be a far far better remedy for me than any pills were. Its really great I have to say.
Contrary to what you might think, I am actually open minded about the whole thing - it was my belief a few years ago that there was a 'cure' but now, after everything I've seen, I think SSRIs, in particular, are not very good - to put it mildly, and I don't think the pharma companies are being particulary honest about their findings either.
Hence why I like this study because it actually includes unpublished data that the pharma companies didn't publish (presumably because it shows their drugs in a bad light).
So. I used to be pro-SSRIs, now I'm very much anti. Or rather, I just don't think they work particulary effectively and I wish people would see that. And I think you'd be better spending your health and time and money doing something else to help. And I think there's alot to be said for getting to the root cause of the depression/anxiety etc rather than just using drugs to mask the symptoms - because otherwise you'll end up with a lifetime of AD drug use, which I don't consider to be particulary healthful. You might want to take that risk, but I certainly don't and won't.
Posted by bulldog2 on April 17, 2008, at 12:10:26
In reply to Re: They just don't work. FACT. - Who cares? :-), posted by Betula on April 17, 2008, at 9:13:07
> Sure, I could find magic pills that would relieve me of my OCD/anxiety/depression, but they would just mask the underlying cause. The depression etc would return once I quit the pills. And this I know because I've been down that route.
>
> I do not think it is healthy to take these pills indefinately. I view them as short term band aids to help you get through tough periods. That is all. I do not think they were even designed to be taken for extended periods of time, or at least, certainly the SSRIs weren't. And I certainly do not want to be one of those ones who become addicted for life or have terrible discontinuation sydromes. And let us not forget they haven't been around for all that long - who knows what happens to you if you take Effexor (yes, I know not technically an SSRI, but the same principles apply) for 20 years and try to wean off?? The drug companies sure as hell don't know. I am really not convinced we know enough about SSRIs to really say for sure. And let us not forget the pharma companies hiding information about the increased risk of suicide. Even if they didn't hide it, at least this is something unpredicted to come out of these drugs. Who knows what'll happen with say, 25+ years of use of lexapro? No-one simply knows for sure.
>
> Actually, for me, therapy is proving to be a far far better remedy for me than any pills were. Its really great I have to say.
>
> Contrary to what you might think, I am actually open minded about the whole thing - it was my belief a few years ago that there was a 'cure' but now, after everything I've seen, I think SSRIs, in particular, are not very good - to put it mildly, and I don't think the pharma companies are being particulary honest about their findings either.
>
> Hence why I like this study because it actually includes unpublished data that the pharma companies didn't publish (presumably because it shows their drugs in a bad light).
>
> So. I used to be pro-SSRIs, now I'm very much anti. Or rather, I just don't think they work particulary effectively and I wish people would see that. And I think you'd be better spending your health and time and money doing something else to help. And I think there's alot to be said for getting to the root cause of the depression/anxiety etc rather than just using drugs to mask the symptoms - because otherwise you'll end up with a lifetime of AD drug use, which I don't consider to be particulary healthful. You might want to take that risk, but I certainly don't and won't.
>Some have endogenous depression and do not respond to talk therapy. For years before the age of ADs people did only talk therapy and some just did not respond.
I agree if talk therapy plus diet,supplements and exercise, transendental meditation work than that is the best road. Also maois and tcas have been around for around 50 years. There is so much more than ssris if you have a skilled pharmacologist.
There are some who have depression caused by life circumstances and they may respond to talk therapy. But like any organ in the body the brain can also be malfunctioning and talk therapy cannot fix that. Many people committ suicide each year because their depression is not adequately treated. All meds have potential sides and we treat our high bp, high cholesterol etc..Yes diet and exercise would be preferable for these conditions but drugs still are there when other measures have failed.
Really won't post more on this thread..It's getting beaten to death. But remember what worked for you won't necessarily work for others and what didn't work for you may work for others.each person't situation and chemistry are unique. We have a tendency to think that we can extrapolate our experiences and believe that's how it will play out with others.
Posted by Shadowplayers721 on April 17, 2008, at 15:02:15
In reply to Wierd Some I know In real Life Feel Better off ADs, posted by Phillipa on April 14, 2008, at 13:40:46
I have been under the impression that people suffer from different types of depression. Some types of depression can be chronic, self-limited, or recurrent.
Therefore, the medication needs would be very individual and would change accordingly.
On a high note.: It's great to hear that some are feeling better without medication & no longer in need of it. :)
Posted by Shadowplayers721 on April 17, 2008, at 15:15:33
In reply to They just don't work. FACT., posted by Betula on April 16, 2008, at 11:51:18
I would like to read the actual case study. Do you know where I may find that link? Thank you.
Posted by Larry Hoover on April 17, 2008, at 15:27:51
In reply to Re: They just don't work. FACT., posted by Shadowplayers721 on April 17, 2008, at 15:15:33
> I would like to read the actual case study. Do you know where I may find that link? Thank you.
I did a critique of the actual article, within which is a link to the full text. See: http://www.dr-bob.org/babble/20080221/msgs/815551.html
Lar
Posted by 10derHeart on April 17, 2008, at 15:56:49
In reply to Re: They just don't work. FACT. - Who cares? :-), posted by Betula on April 17, 2008, at 9:13:07
I believe in some cases - maybe I'd even say many cases - people aren't at all "just using drugs to mask the symptoms." For example, say someone does want to get to the root of the illness (and I'm not at all sure that concept applies across the board) through therapy, they first have to somehow find a therapist, call a T. for an appointment, and get themselves to that therapist's office. For people with crippling depressive or anxiety symptoms, well, you might as well ask them to climb Mt. Everest.
If you can't get out of bed, can't eat, sleep, and/or suffer from symptoms such as severe apathy, lethargy, anxiety, tearfulness, etc., you often can't even imagine doing things like picking up a phone, dressing yourself or driving to a therapist's office.
I'm just saying you can't be helped by therapy if you are too ill to "do" therapy. This is where even a somewhat effective AD can be a life-saving and critical tool for some people.
Posted by Larry Hoover on April 17, 2008, at 16:01:27
In reply to Re: They just don't work. FALLACY. » Shadowplayers721, posted by Larry Hoover on April 17, 2008, at 15:27:51
> > I would like to read the actual case study. Do you know where I may find that link? Thank you.
>
> I did a critique of the actual article, within which is a link to the full text. See: http://www.dr-bob.org/babble/20080221/msgs/815551.html
>
> LarI just took a quick read through what I wrote earlier, and I realize that I might have expressed one point a little more clearly. What I said was:
"Now, here's a very illustrative figure, Figure 4: http://medicine.plosjournals.org/perlserv/?request=slideshow&type=figure&doi=10.1371/journal.pmed.0050045&id=96831
First, the zero line is no difference (i.e. superiority) of drug or placebo. Below zero is placebo superiority, whereas above it is drug superiority. What's the pattern tell you? Do we find just as many points below the zero line, and just as far from it, as we do above it? "
What I should then have done is answer the question. The answer is a resounding NO! But, that's what we'd see if there was no difference between placebo and drug response. We'd see similar scatter above and below the zero effect size line. Instead, we see near absolute dominance of drug over placebo, and often times very substantial dominance, in individual trials.
The paper's conclusions are unsupported by the evidence.
In fact, Kirsch might have argued that the cost of psychotherapy could be eliminated by sugar pills, but I doubt he'd have suggested that.
Lar
Posted by 10derHeart on April 17, 2008, at 16:01:58
In reply to Re: They just don't work. FACT. - Who cares? :-) » Betula, posted by 10derHeart on April 17, 2008, at 15:56:49
I didn't mean in some cases there are people who don't want to get to the root, i.e., find out the basics of what might be causing their illness. I meant I'm unsure - and I think so are the "experts" - that there is any specific "root" to be able to get down to...biology, situational, both, etc. it's just so often about as clear as mud 'why' any given person is suffering from depression.
Hope *that* was a little clearer than mud.
Posted by SLS on April 17, 2008, at 16:31:13
In reply to just to clarify one part..., posted by 10derHeart on April 17, 2008, at 16:01:58
BIOLOGY OR PSYCHOLOGY?
The best answer to this question may be "either and both".
Many of us here have been diagnosed as having a mental illness. Mental
illnesses are NOT mental weaknesses. The diagnoses that we are most
familiar with include:1. Major Depression (Unipolar Depression)
2. Bipolar Disorder (Manic Depression)
3. Dysthymia (Minor Depression)
4. Seasonal Affective Disorder (SAD)
5. Schizophrenia
6. Schizo-Affective Disorder
7. Obsessive-Compulsive Disorder (OCD)
8. Post-Traumatic Stress Disorder (PTSD)All of these disorders have one thing in common. They are not our fault.
Each has both biological and psychological components. We all begin our
lives with a brain that is built using the blueprints contained within the
genes we inherit from our parents. Later, hormones change the brain to
prepare it for adulthood. The brain can be changed in negative ways by
things such as drugs, alcohol, and injury. The brain is also changed by
the things we experience.How we think and feel are influenced by our environment. Probably the most
important environment during our development is that of the family, with
the most important time being our childhood. We all have both positive and
negative experiences as we travel through life. How we are as adults is in
large part determined by these positive and negative experiences. They
affect our psychology, our emotions, and our behaviors. All of us can be
hurt by unhealthy negative experiences.Some of us are also hurt by unhealthy brains. Medical science has long
recognized that many mental illnesses are biological illnesses. Even
Sigmund Freud, who we know for his development of psychoanalysis, proposed
a role for biology in mental illness. The first solid evidence for this
concept in modern times came with the discovery of lithium in 1947.
Lithium was found to cause the symptoms of bipolar disorder (manic-
depression) to disappear completely, allowing people to lead normal lives.
Lithium helps to correct for the abnormal biology that is the cause of
bipolar disorder. Later biological discoveries included the observations
that the drug Thorazine (an antipsychotic) successfully treated
schizophrenia, and that Tofranil (an antidepressant) successfully treated
depression. Again, these drugs help to correct for the abnormal biology of
the brain that accompanies these illnesses.What about psychology? What role does it play in mental illness? This can
be a two-way street. The abnormal biology that occurs with some mental
illnesses affects our psychology how we think, feel, and behave. On the
other hand, our psychology can also affect our biology. As we now know,
the emotional stresses and traumas we experience change the way our brains
operate. This is especially true of things we experience during childhood.
These stresses can trigger the induction of abnormal brain function that
leads to major depression, bipolar disorder, schizophrenia, and other
major mental illnesses. In order for this to happen, however, there must
be a genetic or some other biological vulnerability to begin with.Unfortunately, there are still too many people who cannot bring themselves
to believe that the most common mental illnesses are actually brain
disorders. However, the vast majority of our top researchers in psychiatry
and neuroscience do.The National Institutes of Health, the federal governments official
repository of medical research, has made available to the public free
publications describing the current research into psychiatric disorders.
They include descriptions of the biological and psychological aspects of
major mental illness. Each of their press releases and research
publications begin by stating emphatically that these are indeed brain
disorders.NIMH Public Inquiries
6001 Executive Boulevard, Rm. 8184, MSC 9663
Bethesda, MD 20892-9663 U.S.A.
Voice (301) 443-4513; Fax (301) 443-4279
TTY (301) 443-8431It is important to understand that not all psychological and emotional
troubles are biological in origin. Again, we are all products of our
environments family, friends, enemies, school, work, culture, climate,
war, etc. Environments that are unhealthy often produce unhealthy people.
This, too, is not our fault.In conclusion, regardless of the cause of our mental illnesses, it is
important that we treat both the biological and the psychological. We will
all benefit most if we do.
Posted by antiserial on April 17, 2008, at 17:24:22
In reply to Re: just to clarify one part..., posted by SLS on April 17, 2008, at 16:31:13
"Unfortunately, there are still too many people who cannot bring themselves
to believe that the most common mental illnesses are actually brain
disorders. However, the vast majority of our top researchers in psychiatry
and neuroscience do."Of course NIMH would say something like that, as they're just another tentacle of the Psychopharmaceutical Industrial Complex.
Posted by SLS on April 17, 2008, at 19:16:28
In reply to I'm sorry, but NIMH isn't a trustworthy source » SLS, posted by antiserial on April 17, 2008, at 17:24:22
> "Unfortunately, there are still too many people who cannot bring themselves
> to believe that the most common mental illnesses are actually brain
> disorders. However, the vast majority of our top researchers in psychiatry
> and neuroscience do."
>
> Of course NIMH would say something like that, as they're just another tentacle of the Psychopharmaceutical Industrial Complex.
Ok.
- Scott
Posted by okydoky on April 17, 2008, at 21:37:47
In reply to Re: I'm sorry, but NIMH isn't a trustworthy source, posted by SLS on April 17, 2008, at 19:16:28
Scott,
Have not heard from you in a while. I see you are doing very well and I am enormously glad for you.Wishing all the best for you and that everything continues to go well. Live life to its fullest, you deserve it. I think just from reading some of the posts through the years most of us have come to know you as a very good caring kind person and appreciated you for reaching out to some of us in our times of need and sharing your stories.
Take care of yourself,
Irene
Posted by Shadowplayers721 on April 18, 2008, at 0:17:14
In reply to Re: They just don't work. FALLACY. » Shadowplayers721, posted by Larry Hoover on April 17, 2008, at 15:27:51
Based on my examination of the study, I did not find conclusive evidence that these medications were ineffective.
It appeared to me, the study was actually trying to obscure improvements made by participants receiving medications.
Those graphs in the study were quite unusual.
Mr. Hoover, you did an exceptional job of reviewing this study. To be sure, it wasn't an easy task. I think that I read over this study at least four times.
Posted by antiserial on April 18, 2008, at 4:04:24
In reply to Re: Wierd Some I know In real Life Feel Better off, posted by SLS on April 15, 2008, at 20:16:27
>There are magic pills.
The only true magic pill in existence is called placebo. No adverse effects and no dependancy.
Posted by SLS on April 18, 2008, at 5:28:22
In reply to Re: I'm sorry, but NIMH isn't a trustworthy source, posted by okydoky on April 17, 2008, at 21:37:47
Hi Okydoky
> Have not heard from you in a while. I see you are doing very well and I am enormously glad for you.
Thanks!
I am enormously thankful for your well-wishes.
Take care.
- Scott
Posted by SLS on April 18, 2008, at 5:30:46
In reply to Re: They just don't work. FALLACY., posted by Shadowplayers721 on April 18, 2008, at 0:17:14
> Mr. Hoover, you did an exceptional job of reviewing this study.
Larry's the man!
We are indebted to him for his contributions.
- Scott
Posted by SLS on April 18, 2008, at 5:31:33
In reply to Magic pills » SLS, posted by antiserial on April 18, 2008, at 4:04:24
> >There are magic pills.
>
> The only true magic pill in existence is called placebo. No adverse effects and no dependancy.Ok.
- Scott
Posted by Phillipa on April 18, 2008, at 13:23:24
In reply to Re: Magic pills » antiserial, posted by SLS on April 18, 2008, at 5:31:33
Fellow babblers since I started this thread I'd just like to add that some have medical chronic problems which can present as anxiety and depression so treatments may vary.Not all chose to disclose all the medical problems. Thanks for your understanding. Phillipa
Posted by Betula on April 19, 2008, at 3:41:34
In reply to They just don't work. FACT., posted by Betula on April 16, 2008, at 11:51:18
Hello all!
Its great we have an open debate about these sorts of things.
Here is the link to the webpage of the lead author of that article:
http://psy.hull.ac.uk/Staff/i.kirsch/
So. I'm going to make some points.
1) One paper doesn't prove a theory - it takes quite a few for something to become universally accepted.
2) The author is a PROFESSOR at a large civic university in the UK. (note its harder to become a professor in the UK - there doesn't exist sub categories such as 'assistant professor' etc as there does in other countries.) I doubt any of us here are actual professors. He has quite a distinguished publication record - again, something I'm sure none of any of us have.
3) The paper got published in a reputable, peer reviewed journal. That means that it was reviewed by other academics working in precisely the same field as him. They must have thought it acceptable for publication, otherwise, it would be sent to the trash. And it took a year from submission to acceptance, so that would imply it had a couple of revisions at least. So the peer reviewers would have been doing their job properly.
4) The journal the paper appeared in, PLoS Medicine. Journals do not want to lose money. The reputation of a journal (and also of the authors for that matter) quickly goes down the drain if they publish something that is trash. Other academics quickly see through fudged results etc. This means that journals select the very best papers they can. Therefore, I highly doubt that this paper is 'flawed' in any way.
5) Therefore I personally believe that this paper would not have been published if it were faulty/flawed/trash in any way. IT WAS PEER REVIEWED for heavens sake!
6) I personally do not believe dismissals of the paper coming from people in general, unless they are a) the authors of the paper or b) suitably qualitifed academics working in the field i.e. the 'peers'. Its as simple as that.
7) Of course, science evolves and develops and new things come to light, but at this time, I think that this paper is valid and the conclusions should be accepted into the bigger the scheme of things, including papers that show 'the drugs work'.
Posted by Betula on April 19, 2008, at 6:26:49
In reply to OOOOOOOOOOOOooooooooo, posted by Betula on April 19, 2008, at 3:41:34
And oh, I meant to say, why is it so that people can not accept the conclusion of the paper?
Does it challenge your world view in such a way that you simply have to deny the findings of it? Well, it would appear so.
Of course things are never black and white. This paper might be a complete and utter anomaly, (like I said before one paper doesn't really 'prove' anything) but that doesn't mean we can't consider it, relfect on it, and see that the authors may have some very good points.
We shouldn't readily dismiss it because it challenges our beliefs. It makes me sad to see that people are so very narrow minded.
Goodday to everyone, and I'm leaving now.
I do not want to inhabit a playground for people with personality disorders.
So please block me.
Posted by SLS on April 19, 2008, at 7:20:02
In reply to Re: OOOOOOOOOOOOooooooooo » Betula, posted by Betula on April 19, 2008, at 6:26:49
> And oh, I meant to say, why is it so that people can not accept the conclusion of the paper?
Kirsch is well known for his history of hystrionic papers condemning all of psychiatric medicine as a conspiracy of capitalists.
I have read several of his papers. In response, there have been papers who have focused on Kirsch's lack of recognition of treatment efficacy of drugs for what I consider to be his emotional attachment to his own ideas. He takes papers that conclude that drugs works and takes snippets from them and uses them out of context.
That's just a start.
If you want more of an arsenal for your hatred of drugs, you might want to look at the work of Peter Breggin. I've read his stuff, too. Again, I find an emotional attachment to his need to decry modern psychiatry.
Why are you so angry? You don't think modern medicine is actively pursuing better treatments for psychiatric disorders? Even if it is a matter of profit, it escapes most people that it is easier to make money off of a good drug than a bad one. To develop a novel drug that works better is goal of both R&D and sales.
Why are you angry at the use of the best treatments science has yet come up with to date? Imperfect drugs are better than none at all.
By the way, drugs work.
If you feel such an urgent need to leave this forum, perhaps it would reduce your psychosocial stress to do so. This would greatly reduce the pressure you put on your brain. Just a thought.
There has got to be a more effective way to get your points across other than to get blocked from posting on purpose for calling people names. As a community, we welcome new ideas.
Personally, I have never been wrong. One time, I thought I was wrong, but it turns out that I was mistaken.
- Scott
Posted by Racer on April 19, 2008, at 8:45:08
In reply to OOOOOOOOOOOOooooooooo, posted by Betula on April 19, 2008, at 3:41:34
>
> 2) I doubt any of us here are actual professors. He has quite a distinguished publication record - again, something I'm sure none of any of us have.
>We do have a few professors, and a few of us here do have fairly impressive publication records. Not necessarily in psychopharmacology, but I hope that you will consider offering your praise of others without having to include the contrast to posters here.
It's fine to say, "Hey, this is a professor, and he's got a great publication record," without adding in, "...unlike all of you here." In fact, for some of us, it would carry more weight if you did.
Posted by linkadge on April 19, 2008, at 10:30:17
In reply to Re: OOOOOOOOOOOOooooooooo » Betula, posted by SLS on April 19, 2008, at 7:20:02
Hi, I know I said I quit psychobabble and for the most part I have, but I was passing by and can't resist a good argument of this nature.
I have to completely agree with Betula (no surprise) and cannot let him go on this solo mission.
It reminds me of some good Simon and Garfunkle lyrics, domething along the lines of "a man hears what he wants to hear and disregards the rest", I think it was "The Boxer".
Anyhow, the point is with these drugs, is that it doesn't matter how much you talk to people about their lack of established efficacy, you are still going to get people who refuse to look at good science like this.
Then you get those babblers who are resorting to the very devices they condemn. The very babblers that suggest that single case reports are weak seem return to the logic that "they work for me, and that's all that matters". To some extend they're right, this is all that matters.
I think the study that Betula brought up is very important, becase it is infact *not* just one study. It is a meta analysis of 47 other studies and the largest one of its kind to date. As mentioned it includes data that the drug companies conveniently left out which increases its validity beyond any one single study or any previous subgroup of *more positive* released trial data.
Saying that Kirsh is biased only goes so far. If you are going to make a substantial argument that he has somehow biased this data than do so. I have not seen one person pose a good reason why his methodology is flawed in some way. He was using standard methods of statistical analysis as far as I know, can you or anyone point to his flaws?
Even those of you who publicly dismiss this study are probably saying to themselves "man, this really sucks".
The clinical trial is unfortunately the only real way to scientifically establish the efficacy of antidepressants. Other forms of persuasion are not scientific and therefore don't mean a whole lot. People poked holes in sick patients heads to let the "evil spirits" out for years and it was hard to convince them that their practice was flawed. You see, when you believe there is an association between two things, there is a tendency to only see information that favors that association and to dismiss contradictory information as being flawed. I am young enough that I can get out of the "antidepressant cult" but there are others that have been in it too long and it is unlikely that they will be able to ever get out. Its called "belief perseverance" I think. When people make certain faulty conclusions, it tends to stick even in the face of contradictory information.
Another thing to consider is this: Most people are here because their antidepressant is not working the way they would like it to. That's why I take their proclamations with a grain of salt. Many of the people here arguing may just be doing so to re-establish their faith in the drugs. It's like...it seems like you're more trying to convince yourself. Its just like my brother at Bible college. Even he admits that arguing for Christianity bolsters his faith when even he is doubting it. After all, arguing a particular point of view is the first step to believing it.
The idea that it is hard to distinguish antidepressants from placebos is not new and has long preceded this study.
What always surprises me though is that if this kind of meta analysis occurred for a cholesteral lowering drug ie. you found out that you were taking a certain cholesterol lowering drug that was generally no better than placebo, most people would note get all defensive. Probably because there isn't the same kind of surge in introspection upon initiation of a cholesterol drug.
The argument for endogenous depression is a valid one. But, provide me any data anywhere that the current line of antidepressants addresses any one proven chemical imbalance. For instance, the majority of the findings suggest that SERT activity is in fact low in depression. You're not targeting any imbalance by giving SERT inhibitors to these individuals. Other studyies suggest that NET is low and even MAO is decreased.
People can, and often do feel better off drugs. This is in no way a sign that their depression is not due to some biochemical abnormality. Like mentioned above, it would seem reasonable to me that an individual with an already abnormally low level of the serotonin transporter takes a drug that lowers it further, they may just feel worse. I know severely depressed individuals who simply feel worse on drugs period. Psychiatry does not have all the tools and all the answers.
If anything I would hope that some of the current studies could help liberate certain individuals. You see people on this board who have never (or rarely) helped by an antidepressant, yet they somehow feel that the drugs work and there is something wrong with them when they don't. I would hope that data like this would be liberating. I.e. perhaps by seeing that they don't work for others too, they might stop beating themselves up about the issue and go look for answers somewhere else.
So, I digress. The establishment of a solid logical arugument does not depend on the ability to convince of any one individual. The more I am away from babble the more I realize how much "GroupThink" goes on here. One person talks about a drug then all of a sudden another person needs it. Also, the more time you spend on a board discussing drugs, the more you don't see the other ways that you can address your problems. Petting a dog will raise your serotonin you know.
Its just like some of the issues brought up by Bulldog. Many people are just at their wits end in terms of who to believe about who has the answers for their problems. Believing that prescription antidepressants are the only ways to solve your problems is seductively convenient. It allows you to narrow your focus and disregard other useful information. It makes life easy, or does it?
If the drugs work for you, then great: live happily ever after. For the rest of us, don't be so surprised and upset when you're not getting prozac.com type results. Trust yourselves for a change, and reflect critically upon data like this. It may be more liberating than you know.
Anyhow, I just thought I'd stop by and say hi.
To somebody who was on lithium, zoloft, depakote, zyprexa, clonazepam and ritalin, (all at once) and told by top psychiatrists that I will never be able to live medication free, diet, exercise, and certain supplements have gone a long way.
Obviously not all cases are like this, but the point I am trying to make is to never stop rethinking and reasessing exactly what the meds are and are not doing for you.
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Dr. Bob is Robert Hsiung, MD,
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