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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 74 to 98 of 166. Go back in thread:
Posted by linkadge on July 11, 2006, at 17:02:02
In reply to Re: couldn't have said it better myself » linkadge, posted by SLS on July 10, 2006, at 21:34:12
Hey, this buisness is rife with conspiracy.
Linkadge
Posted by linkadge on July 11, 2006, at 17:24:48
In reply to Re: couldn't have said it better myself, posted by Klavot on July 11, 2006, at 6:45:49
>Are you telling me that the thousands of >medical scientists, and millions more medical >doctors, who are behind contemporary >psychiatry, are all wrong? That they are all in >the pockets of Big Pharma?
Just like it was mentioned below, 50 years ago, methamphetamine was used to treat depression. The doctors who pused it probably claimed that it was treating some genuine biochemical abnormality, and the people who took it probably believe in it based upon the notion of "how could these doctors be wrong?" Its "The Emperor's New Cloths".
>If drug-based psychiatry is so flawed, then why >are psychiatric hospitals at an all-time low?
Because drug-based psychiatry is so flawed.
>It seems to me that there are some people on >this board who, based on their own isolated >anecdotal exeriences with psychiatric drugs, >are hell-bent on discrediting these drugs.
The drugs will discredit themselves. The operative demention here is time. I have my own opinions, but thats no proof in itself. I don't believe in opinion. I try to take information and process it for what it is, information.
Breggin, maybe he's a bit of a nerd. When he asserts that ECT seems to cause significant and observable abornmalities in glial function, I take that for what it is, either true or false. If you think in black and white, and lable Breggin as bad, and assume everything he says is wrong because he is bad, then you may be missing the whole story. We all like to compartmentalize information because it helps us cope with the decisions we must make.
>I would also be careful to take everything that >I read on the net seriously. The internet is >often the medium of quacks, who are unable to >have their work published in proper literature.
I don't read an article with preset opinions. He brought up the point about why no placebo was used. I never thought of that, its a good point. If the placebo showed what it was probably going to (which might make the already dismal responce rates seem even more insignificant), one might reconsider its use.
>By the way, is is not a given that you MUST use >a placebo in clinical trials. Often the >efficacy of a treatment is compared not to a >placebo, but to other well-established >treatments, particularly where it is unethical >to use placebo (for example cancer drugs).Yes, but cancer doesn't get better with hope (at least in my books), but depression can, and often does. That's why a placebo is so critical in the trial of depression drugs. It gives you a guage of the degree to which the setting, care and support, are contrubuting to a person's recovery.
Think of the sertraline, SJW, placebo trial. Without placebo, it would say that 30% of people responded to sertraline (roughly the number of people who responded here), with placebo, you'd see that 40% responded to placebo. All of a sudden, the "response" to sertraline seems virtually nonexistant.
Linkadge
Posted by linkadge on July 11, 2006, at 17:34:13
In reply to couldn't have said it better myself, posted by linkadge on July 9, 2006, at 20:44:50
Those were not his points. The Zoloft/SJW trial is by far not the first trial to suggest that antidepressants often perform worse than placebo.
He suggested that the trial might be biased based on some of the investigators vested interests drug compaines.
He claimed that the results are essentially meaningless without a placebo control.
He also suggested that rates of spontanious remission should be considered by anyone trying to guage the degree to which an antidepressant influcences recovery.
Those are valid considerations.
I don't like Breggin much, but I do have respect for Dr. Kramer. He discusses some of the highlights from a growing body of information about the currently used antidepressants.
Linkadge
Posted by Klavot on July 11, 2006, at 17:53:24
In reply to Re: couldn't have said it better myself, posted by linkadge on July 11, 2006, at 17:02:02
> Hey, this buisness is rife with conspiracy.
>
> LinkadgeIf it is so rife with conspiracy, give me a few examples.
Posted by Klavot on July 11, 2006, at 18:34:40
In reply to Re: couldn't have said it better myself, posted by linkadge on July 11, 2006, at 17:24:48
> Think of the sertraline, SJW, placebo trial. Without placebo, it would say that 30% of people responded to sertraline (roughly the number of people who responded here), with placebo, you'd see that 40% responded to placebo. All of a sudden, the "response" to sertraline seems virtually nonexistant.
Yes, I take your point. The sometimes narrow margin between SSRI's and placebo has bothered me too.
I think one practical and ethical issue is whether to subject a suicidally depressed patient to placebo treatment.
Linkadge, if you don't mind my asking, exactly what is your position on pshychiatric drugs? Are you opposed to all drugs or just SSRI's? Do you believe in drug-based psychiatry or a different treatment approach?
Posted by SLS on July 11, 2006, at 18:41:25
In reply to Re: couldn't have said it better myself, posted by linkadge on July 11, 2006, at 17:01:02
> In my opinion the real response to a drug is that of the trial responce minus the placebo responce.
In my opinion, the real response to a drug will occur whether or not a placebo is being swallowed by the patient in the next room.
Again, they weren't trying to evaluate the efficacy of any one treatment versus placebo. Such studies have already been performed in great numbers. It's time to move on. This naturalistic study design is just another way to observe treatment outcomes and compare alogrithms.
- Scott
Posted by Phillipa on July 11, 2006, at 19:17:13
In reply to Re: couldn't have said it better myself, posted by SLS on July 11, 2006, at 18:41:25
Well as uninformed as I may be compared to a lot of you I base my position on the fact that not one of the antidepressants has done a thing in the ten years I'm been on them. The only positive results I've ever had are benzos. As when my anxiey is down I'm not depressed. And I hated seeing what happened in the psych wards when I worked in one as an RN. A pt would come in on one drug and not be that bad off. A week later I would work on the floor above where the patients were supposed to be in better shape. And when I gave out their meds now instead of one they have two pages of meds and they were worse. And now insurance won't pay for a hospitalization unless you are actively suicidal, homicidal, or totally paranoid, or experiencing hallucinations. In my opinion the AD's dont work. Look at the people that waited so long for EMSAM to come out and now most of them are quitting. Love Phillipa
Posted by linkadge on July 11, 2006, at 21:07:42
In reply to Re: couldn't have said it better myself, posted by Klavot on July 11, 2006, at 17:53:24
One example would be the fact that a drug company does not have to publish or disclose any information on failed drug trials.
Lilly can test prozac and have it fail 9 times out of 10. It is allowed to present the marginal results of a trail or two to get the drug approved.
Some people may not lable that as a conspiracy, but it does show that a company can call a drug "effective" when a analysis of all the information migh lead to no such picture.
Another example might be the fact that Glaxo was fined for supressing information about the likelyhood of paxil to induce suicidiality in children. I suppose they figure nobody wants to know that, so they keep it a secret, and now it has come to the surface.
Linkadge
Posted by linkadge on July 11, 2006, at 21:31:58
In reply to Re: couldn't have said it better myself, posted by Klavot on July 11, 2006, at 18:34:40
I am not against the idea of medication for depression at all. I don't think the idea of medicating depression is wrong.
I just think it is important that people know the whole truth about the drugs.
Some may argue that it is in the patient's best interest that an unrealistically rosey picture of drug performance be presented.
But, if the drugs don't work for you then it might be good to know the whole truth so that you aren't made to feel even crazier than you are.
I did very poorly on antidepressants, and so I was told that I had all sorts of other disorders. I was essentially told that the drugs worked 99% of the time, so I kept trying them. 30 something different psychiatric medications later, I threw in the towel. (I'm only 23).
I'm not telling people not to try drugs, or to have hope in them. I guess I just wish I had an accurate picture of the drugs performance so that I might look to other ways to heal.
Linkadge
Posted by linkadge on July 11, 2006, at 21:33:16
In reply to Re: couldn't have said it better myself, posted by SLS on July 11, 2006, at 18:41:25
>In my opinion, the real response to a drug will >occur whether or not a placebo is being >swallowed by the patient in the next room
Allong the same lines, a true responce to a placebo will occur whether or not an active drug is being swallowed by the patient in the next room.
Linkadge
Posted by gardenergirl on July 11, 2006, at 21:46:36
In reply to Re: couldn't have said it better myself, posted by Phillipa on July 11, 2006, at 19:17:13
> In my opinion the AD's dont work.
I think you're basing this opinion on a relatively small and skewed sample. Or maybe you're saying they don't work for you, which could indicate that depression is not what you're dealing with.
gg
Posted by Phillipa on July 11, 2006, at 22:09:10
In reply to Re: couldn't have said it better myself » Phillipa, posted by gardenergirl on July 11, 2006, at 21:46:36
gg what do you think I'm dealing with in your opinion as I've spent so much money on Ad's. I'm starting the lamictal. But I don't have mood swings. I would be forever grateful to you if you had any ideas. Just ideas. Thanks Phillipa ps it gets so frustrating as I want to go back to work.
Posted by SLS on July 12, 2006, at 5:45:59
In reply to Re: couldn't have said it better myself, posted by Phillipa on July 11, 2006, at 19:17:13
> Well as uninformed as I may be compared to a lot of you I base my position on the fact that not one of the antidepressants has done a thing in the ten years I'm been on them.
This is precisely where I feel I must have an advantage. I have responded robustly to antidepressants on several occasions. I know they work. I can work backwards from there.
- Scott
Posted by SLS on July 12, 2006, at 5:49:52
In reply to Re: couldn't have said it better myself, posted by linkadge on July 11, 2006, at 21:33:16
> >In my opinion, the real response to a drug will >occur whether or not a placebo is being >swallowed by the patient in the next room
>
> Allong the same lines, a true responce to a placebo will occur whether or not an active drug is being swallowed by the patient in the next room.
>
> LinkadgePrecisely. There is no need to have a placebo control for every investigation devised by man. The phenomenology of the placebo response is well quantized. It makes no sense to waste thousands of lives in the STAR*D protocol to test algorithms for drugs that have already been separated from placebo in previous trials.
- Scott
Posted by SLS on July 12, 2006, at 6:14:48
In reply to Re: couldn't have said it better myself » linkadge, posted by SLS on July 12, 2006, at 5:49:52
> > >In my opinion, the real response to a drug will >occur whether or not a placebo is being >swallowed by the patient in the next room
> >
> > Allong the same lines, a true responce to a placebo will occur whether or not an active drug is being swallowed by the patient in the next room.
> >
> > Linkadge
>
> Precisely. There is no need to have a placebo control for every investigation devised by man. The phenomenology of the placebo response is well quantized. It makes no sense to waste thousands of lives in the STAR*D protocol to test algorithms for drugs that have already been separated from placebo in previous trials.Here is an example of a study group smart enough to use the historical records of previous placebo-controlled investigations as comparators for their own three-tier antidepressant remission protocol. It seems to echo the STAR*D findings.
- Scott
Posted by SLS on July 12, 2006, at 7:45:29
In reply to Re: couldn't have said it better myself » linkadge, posted by SLS on July 12, 2006, at 5:49:52
> > >In my opinion, the real response to a drug will >occur whether or not a placebo is being >swallowed by the patient in the next room
> >
> > Allong the same lines, a true responce to a placebo will occur whether or not an active drug is being swallowed by the patient in the next room.
> >
> > Linkadge
>
> Precisely. There is no need to have a placebo control for every investigation devised by man. The phenomenology of the placebo response is well quantized. It makes no sense to waste thousands of lives in the STAR*D protocol to test algorithms for drugs that have already been separated from placebo in previous trials.I guess that was a unclear. What I meant to say is that it makes no sense to waste thousands of lives in a protocol that allocates subjects to a placebo when the drugs being used have already separated themselves from placebo countless of times previously in controlled trials.
- Scott
Posted by Klavot on July 12, 2006, at 8:02:12
In reply to Re: couldn't have said it better myself, posted by SLS on July 12, 2006, at 7:45:29
Apparently there is also correlation between too much sleep and Parkinson's; see
Posted by Phillipa on July 12, 2006, at 10:25:58
In reply to Re: couldn't have said it better myself, posted by SLS on July 12, 2006, at 7:45:29
Scott if you've never responded to an antidepressant does that mean I'm not depressed? That there is something physically wrong even through all my blood test, MRI's have been normal? Love Phillipa.
Posted by SLS on July 12, 2006, at 14:02:01
In reply to Re: couldn't have said it better myself » SLS, posted by Phillipa on July 12, 2006, at 10:25:58
> Scott if you've never responded to an antidepressant does that mean I'm not depressed? That there is something physically wrong even through all my blood test, MRI's have been normal? Love Phillipa.
Obviously, there is some percentage of people with major depression whom don't respond to currently available treatments. You may be in this group. It is also possible that you do not suffer from an affective illness at all, and that there is nothing to be gained from antidepressant therapy.
What is it about what you experience that leads you to believe that you are depressed?
In what ways does Valium help you?
- Scott
Posted by linkadge on July 12, 2006, at 15:52:02
In reply to Re: couldn't have said it better myself » Phillipa, posted by SLS on July 12, 2006, at 5:45:59
>This is precisely where I feel I must have an >advantage. I have responded robustly to >antidepressants on several occasions. I know >they work. I can work backwards from there
I don't call working short term, actually working. Cocaine works short term. MDMA works short term.
I don't think the antidepressants are any different. Why should they work long term? There certainly isn't any clincial data to support the hypothesis that they should work forever. That was just assumed I suppose.
First you filter out the people who don't respond at all, then you filter out the people who respond initially but whoose response poops out. What then do you have left?
Linkadge
Posted by linkadge on July 12, 2006, at 16:06:40
In reply to Re: couldn't have said it better myself » linkadge, posted by SLS on July 12, 2006, at 5:49:52
>It makes no sense to waste thousands of lives >in the STAR*D protocol to test algorithms for >drugs that have already been separated from >placebo in previous trials.
Like I said above, even the 'approved' group of antidepressants may only be better than placebo in 1 out of 10 trials, but because of the way the system works, a drug company can retain all information about failed drug trials. So, to continue to compare these drugs to placebo is absolutely necessary to get the whole picture.
For instance, had a placebo not been used in the SJW, sertaline, placebo trial, we wouldn't have seen that sertraline (a drug that has already supposedly 'separated' itself from placebo) actually performed worse than placebo.
Another reason why it is important to use a placebo to try and guage just how many people might be experiencing placebo effect is because placebo effect will likely not last as long as a real drug effect. So if a good portion of those 50% that ended up responding were actually experiencing placebo effect, then that information could be of major relavance to the patient's long term outcome.
Ie change the study title to, "50% of people can find relief by the third antidepressant but 45% can find relief by the third placebo".All of a sudden, that placebo tells us a whole lot more. To throw away that placebo, is only to fool yourself really.
Linkadge
Posted by linkadge on July 12, 2006, at 16:13:04
In reply to Re: couldn't have said it better myself, posted by SLS on July 12, 2006, at 6:14:48
The below link is not a trial, it is simply a separate summary of some of the inherent problems associated with our currant biases.http://biopsychiatry.com/antidepskep.htm
Linkadge
Posted by linkadge on July 12, 2006, at 16:16:24
In reply to Re: couldn't have said it better myself, posted by SLS on July 12, 2006, at 7:45:29
>I guess that was a unclear. What I meant to say >is that it makes no sense to waste thousands of >lives in a protocol that allocates subjects to >a placebo when the drugs being used have >already separated themselves from placebo >countless of times previously in controlled >trials.
Well, if the placebo is performing better than the active drug, then it makes no sense to waste thousands of lives in a protocol that allocates subjects to an active drug when placebos being used have already separated themselves from placebo countless of times previously in controlled trials.
"Countless" times is nonsensicle IMHO. Remember, a drug company does not have to disclose information about failed clinical trials. Therefore, of course, all you are going to see are the positive trials.
Linkadge
Posted by ttee on July 14, 2006, at 13:09:49
In reply to Re: couldn't have said it better myself » linkadge, posted by SLS on July 10, 2006, at 21:34:12
Off course Mirtazapine and Nortriptyline did not fare well in the Star*D study, as they are both off patent and the scientist don't have to worry about a drug company cutting off their funding.
> > Language, and heated tone asside, he made some very valid points. Why was a placebo arm not used?
>
> I don't believe it was the goal of the study to separate out an active treatment from a placebo. It was an attempt to test treatment algorithms in real-world clinical settings and determine treatment success rates. Placebo response rates in double-blind clinical trials are already well established.
>
> > Were thay afraid of what it might show ?
>
> What makes you think that they would be afraid to show anything? More conspiracy theories? They certainly weren't afraid to show the dismal results of the third step of their treatment algorithm. Neither mirtazapine nor nortriptyline monotherapy produced a remission rate of 20% for those who had failed to respond adequately to the two previous steps. Their reporting was manifestly unbiased. There was no attempt made to declare any of the treatments used as producing a remission rate of greater than 50%.
>
>
> - Scott
>
Posted by SLS on July 14, 2006, at 22:55:22
In reply to Re: couldn't have said it better myself, posted by ttee on July 14, 2006, at 13:09:49
> Off course Mirtazapine and Nortriptyline did not fare well in the Star*D study, as they are both off patent and the scientist don't have to worry about a drug company cutting off their funding.
You might want to read this:
http://www.nimh.nih.gov/healthinformation/stard_qa_general.cfm
- Scott
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