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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 ed_uk on January 2, 2005, at 22:29:02
Have a look at this, you might be very suprised........
Here's a link to the recent UK government report on SSRIs and related ADs...
http://www.mhra.gov.uk/news/2004/SSRIfinal.pdfUsing the 'bar' on the right hand side of the page scroll down to page 165. Have a look at how the efficacy of paroxetine (Paxil/Seroxat) compares to placebo. The results of various trials are presented in a table. As you can see, paroxetine is only slightly more effective than placebo. The MDD studies were especially disappointing.
If you continue to scroll down the page you'll see the data for other ADs, the results are very depressing to say the least.
The results for citalopram (Celexa/Cipramil) in the treatment of depression can be found on page 167 and are almost nauseatingly bad.
Keep scrolling..... the effectivness of sertraline (Zoloft) in the treatment of depression is really quite dire. 50mg Zoloft was only superior to placebo in one out of four MDD trials. In some cases, placebo seemed to be considerably more effective than high doses of Zoloft- probably due to the absence of nasty SSRI side effects.
Keep scrolling.........
Posted by ed_uk on January 2, 2005, at 22:35:55
In reply to SSRIs vs Placebo.... PLEASE READ, posted by ed_uk on January 2, 2005, at 22:29:02
PS. It might take a while for page 165 to come up... but it does eventually and it's worth the wait!
Ed.
Posted by Fallen4MyT on January 2, 2005, at 22:59:16
In reply to SSRIs vs Placebo.... PLEASE READ, posted by ed_uk on January 2, 2005, at 22:29:02
Ed sorry this bummed you out I have never taken an SSRI I am and have always been against them as I feel they are over-pushed and ill-researched compared to many drugs....so this comes as no surprise to me. I have friends on SSRI;S that HAVE to add 4 more drugs to kill the side effects of the SSRI'S and they seem more depressed and have more anxiety and end up on the benzo they wanted to begin with but WITH a SSRI
> Have a look at this, you might be very suprised........
>
> Here's a link to the recent UK government report on SSRIs and related ADs...
> http://www.mhra.gov.uk/news/2004/SSRIfinal.pdf
>
> Using the 'bar' on the right hand side of the page scroll down to page 165. Have a look at how the efficacy of paroxetine (Paxil/Seroxat) compares to placebo. The results of various trials are presented in a table. As you can see, paroxetine is only slightly more effective than placebo. The MDD studies were especially disappointing.
>
> If you continue to scroll down the page you'll see the data for other ADs, the results are very depressing to say the least.
>
> The results for citalopram (Celexa/Cipramil) in the treatment of depression can be found on page 167 and are almost nauseatingly bad.
>
> Keep scrolling..... the effectivness of sertraline (Zoloft) in the treatment of depression is really quite dire. 50mg Zoloft was only superior to placebo in one out of four MDD trials. In some cases, placebo seemed to be considerably more effective than high doses of Zoloft- probably due to the absence of nasty SSRI side effects.
>
> Keep scrolling.........
Posted by Dan Perkins on January 3, 2005, at 0:01:47
In reply to Re: SSRIs vs Placebo.... PLEASE READ, posted by ed_uk on January 2, 2005, at 22:35:55
I'll tell ya, what disgusts me the most about this is not that the responses are so poor (though that does disgust me too) but that the longest running trials we have on the efficay of SSRIs are 6, 8, and 12 weeks long.
I mean, WTF, these drugs have been out for over a decade and that is the best we can do!?!? I don't know anyone who has been on an SSRI for as short a period of time as 12 weeks.
Posted by Fallen4MyT on January 3, 2005, at 0:59:35
In reply to Re: SSRIs vs Placebo.... PLEASE READ, posted by Dan Perkins on January 3, 2005, at 0:01:47
The way I look at it is the people on these meds ARE the test trials subjects. I have known this on the longest running trials for many years. I have always refused to take a SSRI in part due to this
> I'll tell ya, what disgusts me the most about this is not that the responses are so poor (though that does disgust me too) but that the longest running trials we have on the efficay of SSRIs are 6, 8, and 12 weeks long.
>
> I mean, WTF, these drugs have been out for over a decade and that is the best we can do!?!? I don't know anyone who has been on an SSRI for as short a period of time as 12 weeks.
Posted by SLS on January 3, 2005, at 9:20:20
In reply to Re: SSRIs vs Placebo.... PLEASE READ, posted by ed_uk on January 2, 2005, at 22:35:55
Hi Ed.
> Using the 'bar' on the right hand side of the page scroll down to page 165. Have a look at how the efficacy of paroxetine (Paxil/Seroxat) compares to placebo. The results of various trials are presented in a table. As you can see, paroxetine is only slightly more effective than placebo. The MDD studies were especially disappointing.
And how do YOU interpret all of this?
We know these drug do work - and work well - do we not? It's just here on Psycho-Babble that medications in general look disappointing in the context of a very treatment-resistant population - one that does not equate with the general population. Something must be wrong with the studies that were *chosen* to look at.
Don't be so disappointed.
- Scott
Posted by ed_uk on January 3, 2005, at 18:32:43
In reply to Re: SSRIs vs Placebo.... PLEASE READ » ed_uk, posted by SLS on January 3, 2005, at 9:20:20
Hi Scott,
>Don't be so disappointed.
I wasn't really that disappointed because I've seen some of those results before, I thought other people might be quite suprised though.
>And how do YOU interpret all of this?
I think that most (but certainly not all) patients treated with SSRIs for depression would do almost as well on placebo- without the side effects.
>Something must be wrong with the studies that were *chosen* to look at.
Hmmm... a risky assumption.
Anyway, how are you feeling? What dose of nortriptyline are you taking at the moment?Regards,
Ed.
Posted by jerrympls on January 3, 2005, at 21:07:17
In reply to Re: SSRIs vs Placebo.... PLEASE READ » SLS, posted by ed_uk on January 3, 2005, at 18:32:43
UGH. Oh no. I'm switching from Cymbalta to Lexapro! However, I do believe that these meds work. My aunt and brother who both are anti-medication were put on Paxil for depression/OCD and BOTH are feeling much much better. I guess they don't have the TRD gene?
Oh well....I can only hope...
Jerry
Posted by linkadge on January 4, 2005, at 14:08:43
In reply to Re: SSRIs vs Placebo.... PLEASE READ, posted by jerrympls on January 3, 2005, at 21:07:17
Posted by linkadge on January 4, 2005, at 14:11:03
In reply to Re: SSRIs vs Placebo.... PLEASE READ, posted by jerrympls on January 3, 2005, at 21:07:17
Makes you wonder if there is really such thing as an antidepressant.
Linkadge
Posted by Dan Perkins on January 4, 2005, at 14:41:22
In reply to Re: SSRIs vs Placebo.... PLEASE READ, posted by linkadge on January 4, 2005, at 14:11:03
On this placebo topic, I read once that in clinical trials the drug companies supply the placebo pills as well as the active (the real thing) pills and that they sometimes ad substances to the placebo pill that mimic some of the negative effects of the active pills so that the side-effects reported in the active group are relatively comparable to those reported in the placebo group (thus allowing the drug company to downplay the side-effects of their new pill).
I only read this once (I can't quite remember where) and I haven't been able to find anything on this topic since then. It sounds outlandish, but I certainly wouldn't put it pass these corrupt companies to try something like this.
Anyone ever heard of this???
Posted by ed_uk on January 4, 2005, at 15:45:08
In reply to Re: SSRIs vs Placebo.... PLEASE READ, posted by Dan Perkins on January 4, 2005, at 14:41:22
>On this placebo topic, I read once that in clinical trials the drug companies supply the placebo pills as well as the active (the real thing) pills and that they sometimes ad substances to the placebo pill that mimic some of the negative effects of the active pills so that the side-effects reported in the active group are relatively comparable to those reported in the placebo group (thus allowing the drug company to downplay the side-effects of their new pill).
Hi Dan,A 'placebo' pill which contains a pharmacologically active drug is called an 'active placebo'. A active placebo is designed to mimic the side effects of the test drug eg. atopine might be used as an active placebo to mimic the side effects of a TCA because atropine, like the TCAs, causes anticholinergic side effects.
The aim of using an active placebo is to make it more difficult for the participants and assessors to tell who is taking the active drug and who is taking a placebo. This is supposed to reduce bias.
Have a look at this....
Active placebos versus antidepressants for depression.
Moncrieff J, Wessely S, Hardy R.
Psychiatry, University College London, Warley hospital, Mascalls Lane, Brentwood, Essex, UK, CM14 4TU.
BACKGROUND: Although there is a consensus that antidepressants are effective in depression, placebo effects are also thought to be substantial. Side effects of antidepressants may reveal the identity of medication to participants or investigators and thus may bias the results of conventional trials using inert placebos. Using an 'active' placebo which mimics some of the side effects of antidepressants may help to counteract this potential bias. OBJECTIVES: To investigate the efficacy of antidepressants when compared with 'active' placebos. SEARCH STRATEGY: The Cochrane Collaboration Depression, Anxiety and Neurosis review groups's search strategy was used to search MEDLINE (1966-2000), PsychLIT (1980-2000) and EMBASE (1974-2000) and this was last done in July 2000. Reference lists from relevant articles and textbooks were searched and 12 specialist journals were handsearched up to 1996. SELECTION CRITERIA: Randomised and quasi randomised controlled trials comparing antidepressants with active placebos in people with depression. DATA COLLECTION AND ANALYSIS: Since many different outcome measures were used a standard measure of effect was calculated for each trial. A subgroup analysis of inpatient and outpatient trials was conducted. Two reviewers independently assessed whether each trial met inclusion criteria. MAIN RESULTS: Nine studies involving 751 participants were included. Two of them produced effect sizes which showed a consistent and statistically significant difference in favour of the active drug. Combining all studies produced a pooled estimate of effect of 0.39 standard deviations (confidence interval, 0.24 to 0.54) in favour of the antidepressant measured by improvement in mood. There was high heterogeneity due to one strongly positive trial. Sensitivity analysis omitting this trial reduced the pooled effect to 0.17 (0.00 to 0.34). The pooled effect for inpatient and outpatient trials was highly sensitive to decisions about which combination of data was included but inpatient trials produced the lowest effects. REVIEWER'S CONCLUSIONS: The more conservative estimates from the present analysis found that differences between antidepressants and active placebos were small. This suggests that unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos. Further research into unblinding is warranted.
Ed.
Posted by jerrympls on January 4, 2005, at 16:11:28
In reply to Re: SSRIs vs Placebo.... PLEASE READ, posted by linkadge on January 4, 2005, at 14:11:03
> Makes you wonder if there is really such thing as an antidepressant.
>
>
> Linkadgehydrocodone!!
:-)
Posted by Iansf on January 8, 2005, at 1:08:45
In reply to Re: SSRIs vs Placebo.... PLEASE READ » ed_uk, posted by SLS on January 3, 2005, at 9:20:20
> Hi Ed.
>
> > Using the 'bar' on the right hand side of the page scroll down to page 165. Have a look at how the efficacy of paroxetine (Paxil/Seroxat) compares to placebo. The results of various trials are presented in a table. As you can see, paroxetine is only slightly more effective than placebo. The MDD studies were especially disappointing.
>
> And how do YOU interpret all of this?
>
>
Several things are not taken into account with many, if not most, psych drug studies. First, just being in a study, getting regular care, being paid attention to and doing something "important" can give many people a temporary boost. I suspect that once a study ends, many of the placebo takers who reported relief from depression will sink back down.Second, if you ever try to get into a study you'll discover that most long-term sufferers are excluded. Most particpants are people reporting a first depression - which tends to mean people with situational depression who are likely to see the depression lift fairly quickly anyway. Also, many others would be more appropriately categorized as dysthymic., and in general dysthymia appears to be less responsive to antidepressants than full-fledged depression is.
Third, antidepressants often take much longer than than 8 weeks, the typical length of most studies, to take full effect.. If studies lasted 16 weeks or longer, the number of positive responders to the med would likely increase while the number of positive responders to the placebo would remain unchanged -- and possibly even drop..
Fourth, people taking the medication are almost certain to experience more (and more problematic) side effects, which can be discouraging and counteract the lift given by the drug. Yet with time some side effects would lessen, allowing the positive feelings created by the drug to become more evident.
Finally, there are shortcomings of statistics that come into play. For example, take 100 people and give them Paxil and another 100 and give them a placebo. Maybe 15 respond in each group. Now take all 30 responders out. Give Wellbutrin to the remaining 85 drug testers but continue giving a placebo to the 85 remaining in the control group. Maybe you get another 8 responders with Wellbutrin. But you get no more responders from the control group because their "treatment" hasn't changed -- those who were going to respond to placebo already have. Now take the Wellbutrin responders out and put the remaining 77 drug testers on Parnate. Perhaps you find another 5 responders. In the control group you still get no more responders. Keep trying different meds on the remaining nonresponding drug testers and eventually you might have 60 or 70 who find an effective drug. But the number responding to placebo would never go above 10. Thus you get: antidepressant effectiveness, 60-70%; placebo effectiveness, 10%.
This is the end of the thread.
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