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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 45 to 69 of 75. Go back in thread:
Posted by Garnet71 on May 12, 2009, at 11:06:37
In reply to Antidepressants Hardly Help ( Time Magazine), posted by rvanson on May 10, 2009, at 23:31:50
Antidepressant drug trials turn away most of the depressed population
http://www.brown.edu/Administration/News_Bureau/2001-02/01-091.html
Studies establishing the effectiveness of antidepressants are based on highly selective samples of depressed patients. New research by Brown University psychiatrists found as many as 85 percent of depressed patients treated in an outpatient setting would be excluded from the typical study to determine whether an antidepressant works.
--------------------------------------------------------------------------------PROVIDENCE, R.I. While antidepressants are among the most frequently prescribed medications, most patients treated for major depression in a typical outpatient psychiatric practice would not qualify to take part in a clinical trial for a new antidepressant drug, according to a new Brown University study.
Trials to determine the effectiveness of antidepressants have historically evaluated only a small subset of depressed individuals with a very specific clinical profile. People diagnosed with other psychiatric problems and people with mild depression are among those excluded, says the study, which appears in the March 2002 American Journal of Psychiatry....
Posted by SLS on May 12, 2009, at 11:53:24
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by Garnet71 on May 12, 2009, at 11:06:37
> Antidepressant drug trials turn away most of the depressed population
>
> http://www.brown.edu/Administration/News_Bureau/2001-02/01-091.html
>
> Studies establishing the effectiveness of antidepressants are based on highly selective samples of depressed patients. New research by Brown University psychiatrists found as many as 85 percent of depressed patients treated in an outpatient setting would be excluded from the typical study to determine whether an antidepressant works.
>
>
> --------------------------------------------------------------------------------
>
> PROVIDENCE, R.I. While antidepressants are among the most frequently prescribed medications, most patients treated for major depression in a typical outpatient psychiatric practice would not qualify to take part in a clinical trial for a new antidepressant drug, according to a new Brown University study.
>
> Trials to determine the effectiveness of antidepressants have historically evaluated only a small subset of depressed individuals with a very specific clinical profile. People diagnosed with other psychiatric problems and people with mild depression are among those excluded, says the study, which appears in the March 2002 American Journal of Psychiatry....
Does there appear anywhere in these information sources exactly why the selection process exists and what are the criteria used?
- Scott
Posted by SLS on May 12, 2009, at 12:13:23
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by SLS on May 12, 2009, at 11:53:24
I apologize. I see that the article does provide some important information regarding selection criteria. However, it would be nice to interview a series of clinical investigators or the FDA as to why these criteria remain in place, even though it is my contention that in real life, such screening processes are not employed strictly enough.
When you want to find out if a drug will treat a disease, you need to be sure that the subjects you select have the disease in the first place. For now, the exclusive selection criteria are the best these studies have come up with to help insure a valid study population. There is no biological test that a consensus of researchers has determined is specific enough to effectively identify MDD. Not yet. Soon. In the meantime, it is easier to use symptom severity as a guideline to choose subjects.
- Scott
Posted by Larry Hoover on May 12, 2009, at 12:21:14
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by Garnet71 on May 12, 2009, at 11:02:18
The NYT article contains an error that distorts the article. It says "94 percent of the positive studies found their way into print, just 14 percent of those with disappointing or uncertain results did..." In fact, 39% of the latter group found their way into print, and others were included in articles that covered more than one study.
In any case, the drug companies don't publish results. Independent journals do, or don't, as they choose. Surely, articles with significant findings have much better chance at finding their way into print, with that decision subject entirely at the discretion of third-party editors and reviewers. Who would read a journal with inconclusive studies being reported?
In fact, the authors of the NEJM review identified that limiting qualifier in the opening sentence of the 'Conclusions' section of their abstract, but I didn't see it reproduced in any lay press article. It said: "We cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, from decisions by journal editors and reviewers not to publish, or both."
http://content.nejm.org/cgi/content/full/358/3/252
If that criterion could not be determined, then what right have they (the New York Times) to lay the blame on the pharmaceutical companies? Maybe they themselves can't read. Or maybe they themselves have a publishing bias.
In any case, the FDA saw all the studies. The drugs were approved on the basis of fully disclosed clinical trial results.
Lar
Posted by Larry Hoover on May 12, 2009, at 12:25:47
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by Garnet71 on May 12, 2009, at 11:06:37
"New research by Brown University psychiatrists found as many as 85 percent of depressed patients treated in an outpatient setting would be excluded from the typical study to determine whether an antidepressant works."
The exclusion criteria are set by bodies entirely independent of the pharmaceutical companies, in order to provide the most clear-cut evidence for or against efficacy. Exclusion criteria are to minimize confounds. There's nothing sinister about it.
Lar
Posted by SLS on May 12, 2009, at 12:58:38
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » SLS, posted by SLS on May 12, 2009, at 12:13:23
It is instructive to follow the URL links provided in the bibliography. The citations offered are worth reading closely. That is all I would like to say at this time.
- Scott
Posted by SLS on May 12, 2009, at 13:09:22
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by SLS on May 12, 2009, at 12:58:38
> It is instructive to follow the URL links provided in the bibliography. The citations offered are worth reading closely. That is all I would like to say at this time.
I apologize. That is not a very respectable way to engage in a debate. I guess I should actually cite the citations that I found contradictory to the thesis of the NYT article or the others I found that were fraught with their own biases. Maybe later. I have to spend the rest of the day studying for a final exam at school.
Have a nice day, folks.
- Scott
Posted by Garnet71 on May 12, 2009, at 13:49:06
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by SLS on May 12, 2009, at 13:09:22
You guys are making me laugh! I just want you all to analyze the methodologies of the pro-drug studies as much as you analyze the methodologies of the anti-drug studies. Unless for some mysterious reason, you think there is bias on ONLY the one side. 8| Now that would be silly.
If you do this, then I'll pretty much be satisfied with whatever you all think :-)
I've been following this whole thread while on hold during all the personal business calls I've been making over the past 2 days, in between classes; I actually don't have time to read the links and citations! ..but it seems to me some of you ENJOY reading them....an analyzing all this stuff..so I thought I'd leave that up to you while I analyze all my homework assignments..lol.
Posted by Larry Hoover on May 12, 2009, at 14:08:24
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by Garnet71 on May 12, 2009, at 13:49:06
> I just want you all to analyze the methodologies of the pro-drug studies as much as you analyze the methodologies of the anti-drug studies.
I have, and I do.
If conclusions are not supported by the evidence, in my opinion, I make a statement about it. The topic happens to be anti-drug bias at the moment, is all.
If you think there is something wrong with my analysis, then I'm happy to listen to other viewpoints. I learn best from my mistakes.
Lar
Posted by iforgotmypassword on May 12, 2009, at 14:26:50
In reply to Antidepressants Hardly Help ( Time Magazine), posted by rvanson on May 10, 2009, at 23:31:50
are off-patent, that the media actually pays attention to the lack of efficacy and value of the these drugs?
Posted by SLS on May 12, 2009, at 20:29:29
In reply to is it a coincidence that the only after most SSRIs, posted by iforgotmypassword on May 12, 2009, at 14:26:50
> are off-patent, that the media actually pays attention to the lack of efficacy and value of the these drugs?
What makes you think that these drugs don't work?
- Scott
Posted by SLS on May 12, 2009, at 21:08:07
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by SLS on May 12, 2009, at 13:09:22
I'm sorry. My cognitive abilities seem to have betrayed me today. I confused one article with another. Never mind my comments regarding citations. They are not applicable to the Time Magazine article.
- Scott
Posted by SLS on May 12, 2009, at 21:10:04
In reply to Please forgive my confusion..., posted by SLS on May 12, 2009, at 21:08:07
Posted by Phillipa on May 12, 2009, at 21:32:22
In reply to Please forgive my confusion..., posted by SLS on May 12, 2009, at 21:08:07
Scott you expect too much of yourself haven't you also been studying? Lots of brain work. Phillipa
Posted by metric on May 13, 2009, at 12:07:04
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by Larry Hoover on May 11, 2009, at 8:12:22
> I'm sorry, but that Kirsch et al study is complete garbage. I offered a detailed critique of it here: http://www.dr-bob.org/babble/20080221/msgs/815551.html
>
> There were other significant criticisms that ended up in other posts, but this was my main set of issues with it.
>
> I really wish this man would go away. He gives a bad name to cherry-pickers. (Cherry-picking is the act of mining statistics for the rare examples that support an argument that is contradicted by the body of the evidence.)The drug industry is also guilty of cherry-picking (negative results are seldom published for reasons not necessarily linked to financial disincentives as well), which has been a major source of controversy. There was a paper published in the New England Journal of Medicine last year pertaining to publication bias in antidepressant trials:
Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. "Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy." N Engl J Med. 2008 Jan 17;358(3):252-260.
I'm willing to send you the full paper (PDF) if you're interested.
Posted by metric on May 13, 2009, at 12:19:03
In reply to Re: Antidepressants Hardly Help ?????????, posted by chumbawumba on May 12, 2009, at 0:01:07
> Well of course you ask some follow up questions. But my point is that the most sophisticated differential diagnosis is probably no better than asking someone how they are doing. If you think otherwise you've got a lot more faith in psychiatry than I do.
Exactly.
> All the falderol of so called modern psychiatric diagnosis is just a bunch of guys who really don't know anything trying to sound like they do.
Agreed.
> Again I go back to my statement: All phenomenon of mind have a bological concomitant, therefore all depression is biological.
I agree that Scott's use of the term "biological depression" is dualistic and incorrect, though I'd be surprised if he doesn't realize that.
Posted by metric on May 13, 2009, at 13:09:07
In reply to Re: Antidepressants Hardly Help ?????????, posted by SLS on May 11, 2009, at 15:11:05
> Who actually walks through the door? People can feel depressed for reasons ranging from the biological to the psychological to the situational for periods of time that are well over the two week minimum that is the criterion of the DSM IV.
There is no a priori reason to suppose that one group (e.g., "situationally depressed") is more or less responsive to pharmacotherapy than the other. It's also not clear that such groups *are* different.
> Someone with no biological depression can certainly be chronically depressed because of a multitude of psychological and emotional reasons. This is precisely the part of the population of treatment-seeking people who must be EXCLUDED rather than included.
Why?? People become depressed for many reasons. Drug therapy may be appropriate regardless of the cause.
> I contend that these subpopulations DO NOT suffer from having a biological illness that should be the target of these investigations.
If "biological illness" simply means "drug-responsive", then it's tautological to say they shouldn't receive antidepressants. If it means something else, please clarify.
Posted by SLS on May 13, 2009, at 15:04:03
In reply to Re: Antidepressants Hardly Help ????????? » chumbawumba, posted by metric on May 13, 2009, at 12:19:03
> I agree that Scott's use of the term "biological depression" is dualistic
Would you please amplify? What do you mean by "dualistic", and how do you find that my writings relate to your concept of duality?
> and incorrect
You would be shocked to learn that the two of us disagree on what we deem to be incorrect.
> though I'd be surprised if he doesn't realize that.
Now, that's just plain silly. I cannot realize that which I currently believe to be untrue upon much deliberation. If I had believed otherwise, I would have stated otherwise, right?
Major Depressive Disorder (MDD) is a diagnosis for which there are biological correlates as has been demonstrated consistently over the last 30 years.
- Scott
Posted by Chairman_MAO on May 13, 2009, at 19:16:00
In reply to Antidepressants Hardly Help ( Time Magazine), posted by rvanson on May 10, 2009, at 23:31:50
I've been saying this for years, and so have a few professionals that I know. SSRI effectiveness differs from placebo by the
barest of margins, if at all (discount studies funded by drug companies). Virtually all effective antidepressants can only be obtained
with varying degrees of difficulty, e.g.
irreversible MAOIs, buprenorphine, amineptine,
etc.
Posted by SLS on May 13, 2009, at 20:00:28
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » rvanson, posted by Chairman_MAO on May 13, 2009, at 19:16:00
> Virtually all effective antidepressants can only be obtained with varying degrees of difficulty, e.g. irreversible MAOIs, buprenorphine, amineptine,
> etc.What has been your method for identifying these drugs as being effective?
- Scott
Posted by Sigismund on May 13, 2009, at 21:21:47
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » Chairman_MAO, posted by SLS on May 13, 2009, at 20:00:28
Apart from being banned or hard to get?
Anything that's any good will be banned, won't it?
My psych told me.
Posted by SLS on May 14, 2009, at 6:13:13
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » SLS, posted by Sigismund on May 13, 2009, at 21:21:47
> Apart from being banned or hard to get?
>
> Anything that's any good will be banned, won't it?
>
> My psych told me.I disagree. I believe very strongly that most of the drugs currently being classified as antidepressants do work. People who are skeptics of the efficacy of these drugs might prefer to believe that psychostimulants and opioids are the types of drugs that work to treat depression.
Only one antidepressant drug comes to mind that was banned for reasons that I deem unjustified. This drug is known as amineptine (Survector), and is often spoken about on Psycho-Babble. I wish it were available for me to try it. There are some people for whom it was the only drug that ever worked, especially when combined with low dosages of amisulpride. Amineptine is a very dopaminergic drug. It did have a history of recreational use, but the degree to which this happened was a lot smaller than we see with many other available drugs. I think the thing that buried amineptine is that it was used by Olympic athletes to enhance their performance. The Olympic committee banned its use at some point. It was withdrawn from worldwide market not very long afterwards.
Since I have personally witnessed just about every antidepressant produce life-changing therapeutic benefit in the treatment of major depressive illness (MDD), I really cannot agree with the sentiments of others that these drugs don't work.
Even if every single clinical trial of a drug is corrupt for various reasons does not de facto reflect on the efficacy of the drug tested.
- Scott
Posted by Larry Hoover on May 14, 2009, at 6:50:27
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » Larry Hoover, posted by metric on May 13, 2009, at 12:07:04
> Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. "Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy." N Engl J Med. 2008 Jan 17;358(3):252-260.
> I'm willing to send you the full paper (PDF) if you're interested.
Yesterday, I babble-mailed you a "Yes please", but maybe you didn't notice.
Posted by SLS on May 14, 2009, at 6:57:00
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » metric, posted by Larry Hoover on May 14, 2009, at 6:50:27
Is this the same article?
- Scott
Posted by Larry Hoover on May 14, 2009, at 18:01:37
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » Larry Hoover, posted by SLS on May 14, 2009, at 6:57:00
> Is this the same article?
>
> http://psychrights.org/research/Digest/AntiDepressants/080117NEJMSelectivePubofAntidepressantdata.pdf
>
>
> - ScottYes, thank you!
Lar
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