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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by benji on May 7, 2002, at 16:32:13
From Washington Post:
After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work. And so do sugar pills. A new analysis has found that in the majority of trials conducted by drug companies in recent decades, sugar pills have done as well as -- or better than -- antidepressants. Companies have had to conduct numerous trials to get two that show a positive result, which is the Food and Drug Administration's minimum for approval. What's more, the sugar pills, or placebos, cause profound changes in the same areas of the brain affected by the medicines, according to research published last week. One researcher has ruefully concluded that a higher percentage of depressed patients get better on placebos today than 20 years ago.
Full article at:
http://www.washingtonpost.com/wp-dyn/articles/A42930-2002May6.html
Posted by Jaynee on May 7, 2002, at 20:26:46
In reply to Placebos best anti-depressants?, posted by benji on May 7, 2002, at 16:32:13
I have read these articles as well, and it makes me wonder what kind of depression the people taking the sugar pill suffered from. I can tell you now, that there is no sugar pill that will help an anxious depressive.
Anyone who tells you otherwise is full of ..it.
Posted by Bob on May 7, 2002, at 22:58:14
In reply to Re: Placebos best anti-depressants?, posted by Jaynee on May 7, 2002, at 20:26:46
> I have read these articles as well, and it makes me wonder what kind of depression the people taking the sugar pill suffered from. I can tell you now, that there is no sugar pill that will help an anxious depressive.
>
> Anyone who tells you otherwise is full of ..it.
------------I have to agree here. Nobody ever talks about the profile of symptoms, or severity in all these drug trials. It's almost as if a person either has depression or not. Nobody mentions severe depression, severe anxiety, bipolar, pschosis etc. When drug companies try to get drugs approved, they want plain, simple, uncomplicated, light to moderate, straightforward, vanilla depression. They don't want all the other comorbid diagnoses that cloud their findings and are hard to treat. That spells disaster. They like low Hamilton ratings.
To me it's obvious that the less severe one's symptoms, the better chance there is of responding to placebo. This is why they often have failed studies where there is no significant difference between placebo and the drug. People who aren't severely sick are also more appropriate for the short term trials they conduct. TRD patients, and severely ill patients aren't conducive to the 12 week max trials.
Bob
Posted by Jerrympls on May 7, 2002, at 23:09:08
In reply to Re: Placebos best anti-depressants? » Jaynee, posted by Bob on May 7, 2002, at 22:58:14
Well, i read that article this afternoon and it made me think for a long time. When i was put on Zoloft when it first came out I had no idea what it was - I mean it could have been speed for all I knew about antidepressants - my doctor said it was "an excellent medication" and that I'd be "feeling much beter verry quickly" and so on - so, isn't that pretty much a good set-up for a no-miss placebo effect? Well, it didn't work. And each time I took and new antidepressant I hoped it would work but they didn't - so where was the placebo effect for the Zoloft? and then the imipramine? remeron? paxil? wellbutrin? luvox? ascendin? effexor? blah blah blah. Each time my doc would say 'This is the best medication on the market and it's gonna work wonders for you." And of course I would hope and pray it would too. But no....no real and no placebo effect.
Not that I don't think that the placebo effect doesn't exist. I think it's a quite fascinating medical phenomena that should be studied. But, I have to agree %100 with the posts above - the varying degrees of depressions, symptoms, etc. are not taken into account - yada yada yada.
If a sugar pill will cure me - then sign me up.
Jerry
Posted by rainbowlight on May 8, 2002, at 2:02:17
In reply to Re: Placebos best anti-depressants?, posted by Jerrympls on May 7, 2002, at 23:09:08
Yes, please sign me up for the sugar pill too, god knows I have been waiting long enough! LOL! I also wonder what type of depression these subjects have. Could it be situational depression that was cured by all the attention they were given? Maybe they just needed a kind ear to listen. I too find it hard to believe, I have been on tons of med trials and have been dissapointed by most. This is after anxiously driving to the pharmacy believing that FINALLY I had the prescription for the PERFECT drug for me. Well, that was many meds ago and I no longer get the same thrill going to the pharmacy unfortunately!
Posted by Uppendown on May 8, 2002, at 8:05:22
In reply to Re: Placebos best anti-depressants?, posted by rainbowlight on May 8, 2002, at 2:02:17
Hey Ya'll,
You may be right... that in all those 96 studies that were reviewed, conducted from 1979 to 1998.. the studys' constructors ALL managed ONY to include people with lightweight, "mild" "situational" depression, and carefully EXCLUDED anybody else... so that the results would show that the placebos worked better in 52% of the time !! I'm not so sure it is wise to write off these results like that.
I'll be the first one to say I have a *healthy* skepticism of "the system" ( pick one, any one !! LOLOL! ).. But I also am enough of an analyst to recognize the "importance" of the collective results of 96 different studies, conducted by different groups, spanning 20 years! One study ? Big deal.. interesting... But 96 ???
As I said, you may be right... but I wouldn't go to the bank betting on it !!
Best Wishes,Uppendown
Posted by Bill L on May 8, 2002, at 9:12:11
In reply to Placebos best anti-depressants?, posted by benji on May 7, 2002, at 16:32:13
It's an interesting article. It does say however in the parts I copied below that the brain changes are different with AD's than with placebos. It also says that most docs believe that AD's work independently of the placebo effect.
It's hard to be too much credibility on many of the studies. The recent study that showed Zoloft and SJW to be no more effective than placebo was seriously flawed. The dose of Zoloft was less than the amount normally prescribed. Why would anyone do a study using a dose that is too low???????????? It's amazing. Also, these studies are always either 6 or 8 weeks. Either way, SJW takes longer to get a full effect. I used to take Prozac and it took me 3 months to get a full effect. I now take Celexa. Celexa took about 4 months for a full effect.
"Some observers assert that the medicines themselves work because of the placebo effect, but most psychiatrists believe the drugs do have an effect of their own. Drugs are a "placebo-plus" treatment, said Helen Mayberg, head of neuropsychiatry at the Rotman Research Institute at the University of Toronto.
In a study published last week in the American Journal of Psychiatry, Mayberg evaluated brain changes during trials using a sophisticated brain imaging technique. She found that medicines, besides working on areas that are activated by placebos, also work on areas deep in the brain stem, the hippocampus and striatum.
Since both depression and the effect of the medicines are still not well understood, it's not clear what these changes mean. While they could be irrelevant effects, Mayberg said a better explanation is that the drugs affect areas deep within the brain and then work upward to affect parts of the brain that control mood. Placebos may work in the reverse direction. In part, this may explain why drug effects tend to be more reliable than placebos in the long run."
Posted by jonh kimble on May 8, 2002, at 17:14:00
In reply to Re: Placebos best anti-depressants?, posted by Bill L on May 8, 2002, at 9:12:11
well, this is very interesting but i do agree with the many good points brought up here. i do not respond to placebos AT ALL, and im still looking for something that will help. if these cases are mild short term depression, i would guess that many would clear up on there own, even if i hadent read this article. (this may support the article in that mild cases of depression do not require antidepressants right away) just another point that was not brought up. these are 96 studies. how many studies have been done in total on antidepressants and placebos? seems to me these may be selective studies trying to prove a point.nevertheless, very interesting to consider, thanks for posting the article.
jon
Posted by Uppendown on May 8, 2002, at 20:12:26
In reply to Re: Placebos best anti-depressants?, posted by jonh kimble on May 8, 2002, at 17:14:00
Hi Ya'll,
Okay... I'm as skeptical.. if not more so.. than the "average guy"... I've said that here. But, I HAVE to interject here... Posters, who I'll assume are great folks, and undeniably well meaning, are stating things they think were part of the published studies that I sure saw no evidence of... and now I'm seeing others pick up on those thoughts, and are running with them as if they are fact. ( Ooops.. I think this could sound more "intense" than I intend it... ;O) ..)
96 studies, spanning 20 plus years IS significant. If ya can point out that a predominant number of those particular studies reviewed were flawed... PLEASE point that out... I'm all ears... But I don't think that generalizing, without ANY specific refences .. is less than credible, or helpful !
As I've said.. I think the real story in this article/study is the affirmation of the power within each of us... As others have said, few believe that meds hold the total "answer"... at best, it is a combination of meds and therapy... even the authors of the study say the same thing... Meds cannot "solve" all our problems... they can only help us... We still have to do the "work"..
And I think that is true...
Best Wishes,Uppendown
Posted by Bob on May 8, 2002, at 22:39:30
In reply to Nothing was stated that these were mild only .., posted by Uppendown on May 8, 2002, at 20:12:26
I don't think anyone said anything about any of the studies being flawed. I, for one, was only mentioning exclusionary criteria, which for these studies is typically quite strict, thus keeping out extremely ill or suicidal people. Nobody wants a catastrophe in their study. I think spontaneous remission is much less likely in severe cases. Additionally, placebo effects wear off in the long term (which we never see since most studies are 6 to 8 weeks); drug effects tend to last longer.
If a sugar pill will cure me, then bring it on. Why don't they just start secretly switching out real meds for sugar pills. Maybe nobody will know the difference, right?
Yeah... right.
Posted by Uppendown on May 9, 2002, at 11:56:20
In reply to Re: Nothing was stated that these were mild only .. » Uppendown, posted by Bob on May 8, 2002, at 22:39:30
Hey Bob,
I was out and about yesterday, and got into a conversation with someone about all this... and the guy looks at me as if I'm crazy ( LOL! Okay, no wise cracks, please ! LOLOL!)... He goes on to say that his wife, a nurse, worked for a doc who DID hand out placebos to his patients!!! That he had been doing this for along time ! That the majority of his patients reported feeling SO much better..
Man ! Think about the liability issues with THAT one !
Best Wishes,
Uppendown
Posted by Bob on May 9, 2002, at 13:54:06
In reply to Funny you should say that ! , posted by Uppendown on May 9, 2002, at 11:56:20
> Hey Bob,
>
> I was out and about yesterday, and got into a conversation with someone about all this... and the guy looks at me as if I'm crazy ( LOL! Okay, no wise cracks, please ! LOLOL!)... He goes on to say that his wife, a nurse, worked for a doc who DID hand out placebos to his patients!!! That he had been doing this for along time ! That the majority of his patients reported feeling SO much better..
>
> Man ! Think about the liability issues with THAT one !
>
> Best Wishes,
>
> Uppendown
That doc had some BIG cojones! Did he ever get exposed?
If someone gave me a sugar pill without my knowledge and it made me better, I'd be like a pig is s&%t! I would think all the side effects would vanish. Bring it on!
Posted by jonh kimble on May 9, 2002, at 16:05:18
In reply to Funny you should say that ! , posted by Uppendown on May 9, 2002, at 11:56:20
just wanted to clear up my last post. when i said that these studies are probably selective, i really meant that it is a possiblity, not what i assume. (i know that wasnt clear)
i wonder why placebos work? could it be that the exitment of thinking this pill will help may trigger some sort of dopamine boost, sending the mood back up. (just a guess, i dont have any medical backing here) however, after the excitment is gone, i would not be suprised if some of these cases go into remission, as was stated above.
jon
Posted by benji on May 9, 2002, at 18:03:16
In reply to Re: placebos, posted by jonh kimble on May 9, 2002, at 16:05:18
> i wonder why placebos work? could it be that the exitment of thinking this pill will help may trigger some sort of dopamine boost, sending the mood back up. (just a guess, i dont have any medical backing here) however, after the excitment is gone, i would not be suprised if some of these cases go into remission, as was stated above.
>
> jonI wonder even more that anti-depressants don't work any better than placebos, which to me seems close to saying they could have, of themselves, no impact on depression (those changes in other areas of the brain could apparent on the irm imaging could just as soon be signs of a drug-induced dysfunctions a.k.a. side effects).
From personal experience, i never could perceive effects other than side effects (and serious dysfunctions) from these drugs. Looking back, i seem to remember that the further i trudged my way through the range of a.ds, the closer i came to fulfilling the symptoms profile of clinical depression... Of all the drugs i was prescribed over a 31/2 years period, only opiates ever had a discernably anti-depressant effect on me - no placebos, these!
If anything, the results of such studies would lead me to wonder whether the current dominant paradigm of "chemical imbalances" helpfully represents the whole picture - beyond it's undeniably beneficial contribution in reducing the stigma attached to mental disorders.
When the drugs the current model delivers start to significantly outperfom placebos, i'll feel more confortable with trying anti-depression medication again. It's scary that drug manufacturers will run several studies until they can get two to show some effectiveness. Meanwhile, i guess i'll try to make my own way through the lows.
That's me of course, as others will strongly and justifiably feel they have been gratly helped by these drugs.
I appreciate neurologists feel close to unlocking the secrets of the human brain, but, looking at the disappointing efficacy of current a.ds, we're still some while off solving the depression puzzle, wahtever the therapy - or is this depression talking? ;o)
Oh, well...
This is the end of the thread.
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