![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 51 to 75 of 75. Go back in thread:
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
Posted by 49er on May 17, 2009, at 6:17:41
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by Larry Hoover on May 11, 2009, at 8:12:22
Hi Larry,
Is the study really outrageous in light of this statement by Dr. Robert Heydaya, a psychopharmacologist who is definitely not anti meds? This is an exert from a response he posted to someone who had made a comment on his article.
"There are three issues I am raising. First, there is overreliance on antidepressants-action is taken without looking at the WHOLE picture, trying to find underlying correctable causes, which if treated would improve one's overall health and prevent other diseases. Second, depending on the study you read, only 1/3 to 1/2 of all patients treated with antidepressants have a full recovery with the current methods."
Also, since a successful response is based on a 50% reduction in symptoms, that has to be accounted for in the overall success rate.
Additionally, the whole premise of pharma companies who are claiming that antipsychotics are effective add-ons for depression is that ADs only work 33% of the time. So if they are lying, then shouldn't the FTC be getting them for false advertising?
Your point would make more sense if other folks were coming up with higher success rates. But that isn't what is happening.
Anyway, I can't even compete with you in my dreams in analyzing data so if I am missing something that is relevant, please accept my apologies in advance.
49er
Posted by ricker on May 18, 2009, at 21:42:15
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » Larry Hoover, posted by 49er on May 17, 2009, at 6:17:41
> Additionally, the whole premise of pharma companies who are claiming that antipsychotics are effective add-ons for depression is that ADs only work 33% of the time.
As long as I make the 33% club, I'd be a happy camper! :-)Also, 33% for mono therapy may be in the ball-park, hence the need for augmentation strategies
which probably increases ones chance at recovery?Regards, Rick
Posted by jedi on May 19, 2009, at 1:32:18
In reply to Re: Antidepressants Hardly Help ( Time Magazine), posted by ricker on May 18, 2009, at 21:42:15
Hi Guys,
I'll just throw this out for debate. And I do feel like I'm beating a dead horse sometimes. But if a person is correctly diagnosed with atypical depression and social anxiety; Nardil + clonazepam is going to help a majority of these people. And this is when other strategies have failed. We all know that no PDOC is going to try a MAOI first.I would probably go as far as to say that if the above combination does not work, the patient is probably misdiagnosed. Maybe an oversimplification but worthy of debate.
Jedi
Posted by metric on May 21, 2009, at 17:02:46
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » metric, posted by Larry Hoover on May 14, 2009, at 6:50:27
> > 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.Sorry, I'm a bit behind with things.
I see that a link to a PDF of the study has been posted elsewhere in this thread. I also notice that the NEJM has the text freely available online anyway (oops -- I should've checked first):
http://content.nejm.org/cgi/content/full/358/3/252
Posted by Larry Hoover on May 25, 2009, at 8:22:42
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » Larry Hoover, posted by metric on May 13, 2009, at 12:07:04
> 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:
I dispute that conclusion, flat out. There are profound disincentives for publishers/editors including negative or inconclusive papers in their journals. Editors compete for the next scoop, not the next dud. I reiterate this statement, which appeared both in the abstract and the body of the following article:
"There can be many reasons why the results of a study are not published, and we do not know the reasons for nonpublication. Thus, we cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, decisions by journal editors and reviewers not to publish submitted manuscripts, or both."
Blaming the drug companies is biased. Instead, I conclude, as do these authors, that the responsibility for the publication bias cannot be attributed.
> 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've cherry-picked a few extracts from this paper. I'll fully admit selection bias. The authors of the paper exhibit bias, as I will show. I don't think you can write a paper that isn't biased. You have to apply critical thinking, no matter what you read.
One of the most important details in the whole paper, is the following:
"We wish to clarify that nonsignificance in a single trial does not necessarily indicate lack of efficacy. Each drug, when subjected to meta-analysis, was shown to be superior to placebo."So, the FDA did its job. They had all data, and the drugs were properly approved.
The authors of this paper exhibited bias by declaring certain selection criteria that could only result in a negative skew in the statistics they derived, yet they did not discuss the influence of these decisions on those statistics. Here are a couple of examples:
"Few journal articles used the term primary efficacy outcome or a reasonable equivalent. Therefore, we identified the apparent primary efficacy outcome, or the result highlighted most prominently, as the drugplacebo comparison reported first in the text of the results section or in the table or figure first cited in the text."
"Because we excluded articles covering multiple studies, we probably counted some studies as unpublished that were technically published."In the former example, they limited their analysis to one arbitrarily selected outcome determinant, rather than the body of evidence available to them. The FDA looked at all the evidence.
In the latter example, they create a new category of data "technically published", but do not acknowledge this group in their summary statistics on study publication by category. So, they substitute selection bias, while decrying publication bias.
I don't think there is any doubt that publication bias exists. I do question who is ultimately responsible for seeing to it that full disclosure is made, however. IMHO, it falls to the FDA, and their counterparts in other jurisdictions. They are not constrained by the editorial/publication policies of profit-driven journals. Drug companies have supplied all the data, but they cannot force it to be published. There is only one party that could reasonably be expected to do a better job.
Let's not forget that the whole concept of clinical trials of efficacy is a new construct, one that is constantly evolving. Society changes its expectations over time. It's not that long ago that women weren't allowed to vote. It's not fair to history to abstract prior events, and judge them by standards that did not apply at the time those events occurred. We can learn from studying those events, certainly, but the history is simply that.
In the discussion, the study authors move towards that sort of analysis. They contextualize the observed patterns. Here are some of their comments:
"We do not mean to imply that the primary methods agreed on between sponsors and the FDA are necessarily preferable to alternative methods. Nevertheless, when multiple analyses are conducted, the principle of prespecification controls the rate of false positive findings (type I error), and it prevents HARKing, or hypothesizing after the results are known."So, the construct that existed when these studies were conducted was based on statistical and methodolical variables, not specifically addressing antidepressants. Those methods may not be ideal for antidepressant clinical trials, but these specific studies were done under defined protocols.
"It might be argued that some trials did not merit publication because of methodologic flaws, including problems beyond the control of the investigator."
I'm glad they acknowledged this. I have looked closely at some early clinical trials that were included in this dataset, and there were some real problems in methodology. But it was new methodology twenty years ago, and they had yet to learn how to do things well. If you looked at time sequence (which I have never seen analyzed), I bet you'd find a trend from non-significant to significant trial outcomes from the 1980s to the present.
"However, since the protocols were written according to international guidelines for efficacy studies and were carried out by companies with ample financial and human resources, to be fair to the people who put themselves at risk to participate, a cogent public reason should be given for failure to publish."
Well, according to our current standards of disclosure, I would definitely support that. It's inappropriate to retroactively criticize studies completed according to "international guidelines", however.
I want to close with something I've already said. There is only one body that has full access to all the relevant clinical trial data (not just the papers that summarize the research, but the full dataset), that analyzes each study and the body of evidence as a whole, and that determines if efficacy was in fact demonstrated. That's the FDA, or equivalent. They're the only ones with financial independence, also (I'm going to exclude conspiracy theories).
Lar
Posted by Larry Hoover on May 25, 2009, at 10:00:55
In reply to Re: Antidepressants Hardly Help ( Time Magazine) » Larry Hoover, posted by 49er on May 17, 2009, at 6:17:41
> Hi Larry,
Hi, 49er. I'd like to address your closing remark first. You said:
> Anyway, I can't even compete with you in my dreams in analyzing data so if I am missing something that is relevant, please accept my apologies in advance.I don't mean to come across as intimidating. I really don't.
If I spend some time reviewing a study, I try to be as thorough as possible. If I end up writing about a study, I tend to include all the things I thought about. Some studies are so straight-forward, there's really not a lot to say other than "the evidence shows that....blah blah". In other cases, the study conclusions are non sequitur, i.e. they do not follow from the evidence. Or they are severely limited, i.e. not generalizable. Or whatever. It seems to me that the most contentious papers are also severely flawed.
I like to present scientific axioms because they summarize conservative scientific thought. One such axiom is, "Extraordinary claims require extraordinary evidence." So, if the lay press gets hold of an extraordinary claim, and distorts it (typically) to get that sound bite that grabs attention, and I find that the underlying evidence is not correct, let alone extraordinary, I'm all over it.
> Is the study really outrageous in light of this statement by Dr. Robert Heydaya, a psychopharmacologist who is definitely not anti meds? This is an exert from a response he posted to someone who had made a comment on his article.
>
> http://tinyurl.com/p5kaok
>
> "There are three issues I am raising. First, there is overreliance on antidepressants-action is taken without looking at the WHOLE picture, trying to find underlying correctable causes, which if treated would improve one's overall health and prevent other diseases. Second, depending on the study you read, only 1/3 to 1/2 of all patients treated with antidepressants have a full recovery with the current methods."If you're referring to the Kirsch paper as the one that might be outrageous, the answer is yes, it is outrageous. More in a moment.
I agree with what Dr. Heydaya says. The idea that simply taking a friggin' pill is going to fix depression is deeply ingrained in our culture, but it is very inappropriate. If you don't look at stressors and social supports and diet and sleep and exercise and comorbidities and so on, then what do you expect to obtain from an antidepressant? That these factors magically melt away? Somehow? How?
And yes, current treatments have limited success, as measured by short-term studies (some as few as 4 weeks), with all other variables controlled (diet, stressors, blah blah) other than social supports (you get a lot of attention in a clinical trial), with the threshold set at full recovery. Nonetheless, they are significantly better than placebo.
> Also, since a successful response is based on a 50% reduction in symptoms, that has to be accounted for in the overall success rate.
Absolutely. A partial response is still a response. It's a starting point to full recovery, one should hope.
> Additionally, the whole premise of pharma companies who are claiming that antipsychotics are effective add-ons for depression is that ADs only work 33% of the time. So if they are lying, then shouldn't the FTC be getting them for false advertising?
Nobody's lying. They're discussing an alternative to monotherapy. I still question the lack of attention to diet, exercise, etc., but that's not the drug companies' job. It's your doctors' job. And your job.
> Your point would make more sense if other folks were coming up with higher success rates. But that isn't what is happening.My point is about the distortion of evidence to fit an intellectual perspective which is demonstrably false. The Kirsch papers. I consider Kirsch to be intellectually dishonest. Here is a non-exhaustive summary of why I believe that to be the case.
Way back in 2002, Kirsch wrote the first paper I quote below. About six years later, he publishes the second one. Here's what he said about the data he examined:
"'The Emperor's New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration'(2002)
We received information about 47 randomized placebo controlled short-term efficacy trials conducted for the six drugs in support of an approved indication of treatment of depression. The breakdown by efficacy trial was as follows: fluoxetine (5), paroxetine (16), sertraline (7), venlafaxine (6), nefadozone (8), and citalopram (5).""'Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration'(2008)
Forty-seven clinical trials were identified in the data obtained from the FDA. The dataset comprised 35 clinical trials (five of fluoxetine, six of venlafaxine, eight of nefazodone, and 16 of paroxetine) involving 5,133 patients, 3,292 of whom had been randomized to medication and 1,841 of whom had been randomized to placebo."Both studies, six years apart, analyze the exact same evidence, except in the latter one, he excludes data for two drugs. In the latter paper, he does not reveal that he had this information for six years. He makes it sound like he just obtained it, through Freedom of Information requests. My post immediately prior to this one included published and unpublished evidence with respect to the efficacy of 12 antidepressants. Why did Kirsch not reveal that he was re-analyzing data he'd held for six years, and why did he not obtain and analyze data available to others?
The second thing he did was that he retroactively applied an efficacy standard (the NICE guideline) to data collected for another purpose entirely. Notwithstanding the name applied to the studies (clinical trials), they are not intended to demonstrate or predict response outside of the trial environment, i.e. clinical efficacy. They are short-term efficacy trials, and nothing more than that. I know of only one clinical efficacy trial, the STAR*D trial. Although NICE discusses at great length the limitations inherent in applying their standard to simple efficacy trials, Kirsch never once goes there.
Here is the link to the NICE document, which covers every possible treatment for depression, and the evidence that supports (or fails to support) that treatment. I highly recommend that people consider this document as one of the best resources available to them, for evidence-based treatment of depression.
http://www.nice.org.uk/nicemedia/pdf/CG23fullguideline.pdfNow, back to Kirsch. Althought he lifted the NICE guideline from the previously published document (above), or its predecessor (2004), he totally fails to acknowledge that NICE found that antidepressants, and specifically the SSRIs, are recommended as first-line treatment for all but mild depression. And in mild depression that persists, they do recommend antidepressant treatment.
Kirsch then applies statistical treatments to the clinical trial results that are totally inappropriate. The HAM-D (Hamilton Depression Scale) is an ordinal scale. It's not like height in inches (an interval scale), where every inch is the same size, and if you measure it twice you should get the same result, or if someone else measures it, they should get the same result. Instead, for the HAM-D, the numerical value obtained is the sum of the individual's impression of their depressive symptoms. The interpretation of the questions and the answers is probably just as individual.
Just to contextualize that, I've seen people post about having the most severe depression imaginable. It's affecting their work, and wowzers, it even makes going to a party unenjoyable. Eh, what?!? You can work and go to parties? I've gone years unable to work, or lengths of time unable to feed myself and bathe regularly. Party? Would that other guy's score on the HAM-D be comparable to mine, and indicate similar degrees of depression?
Moreover, the test-retest reliability of the HAM-D is not perfect. If you give the test twice to the same person, but rearrange the questions, there is often a different score. Also, consider if the difference between a score of say, 5 and 6 (not depressed), is the same magnitude of difference as that between 25 and 26 (severely depressed)? They both change by one, but are the changes comparable? Who knows?
I hope you get where that takes us. Statistically, you are permitted to rank the scores, and to calculate difference scores for an individual (the change in score over time), but nothing more than that. You can graph how many changed how much in each of a drug or placebo group, or compare percentile ranks in distinct ranges of scores, but that's it.
It has become standard practise to calculate mean changes, and standard deviations, and the statistical significance of any differences in these values for the HAM-D, but strictly speaking, you shouldn't. But absolutely forbidden is what Kirsch did. He did standardization, linear regression, and quadratic factor analysis on statistics (the mean change scores) which themselves shouldn't have been determined. Not only that, he did multiple analyses, and selected the one with the worst outcome for the antidepressants. I've already shown how his statistics do not represent the data. Garbage in, garbage out.
Kirsch is a psychologist. His specialty is deception, suggestion, hypnosis. I cannot believe he did not consider what he did not say in this paper, along with what he did say, and their respective impacts on the reader.
He has argued that drugs are no better than placebo (even though the evidence is quite clear that they are), and NICE demonstrates that there is modest evidence that psychotherapy is equivalent to drug treatment. Using his tortured logic, but using far better evidence, it would be reasonable to conclude that people should forego psychotherapy, and just take a placebo. He should be out of a job.
Lar
This is the end of the thread.
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