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Re: Where would you be without my meds deniseuk190466

Posted by SLS on January 11, 2024, at 11:42:54

In reply to Where would you be without my meds, posted by deniseuk190466 on January 10, 2024, at 10:53:27

Hi, Denise.

It is nice to see you. It is especially nice to see that you feel better.

Thank you for bringing up an old issue with old arguments. I hope it helps give hope to people with TRD.


> If it were me, I would be dead or I would want to be dead and I definitely wouldn't have been able to:-
>
> Do the jobs that I do
> Buy a lovely flat
> Buy and connect with a lovely little dog
> Wouldn't have all the good memories
> Been on some lovely holidays
>
> I owe my life to Antidepressants and relaxants so it frightens me when there are studies that try to claim they don't work.
>
> Tried so much therapy over the years and none of that helped!
>
>
> Just felt like saying that.


I'm glad you haven't lost faith in science. Unfortunately, today's clinical trials are no longer the purview of pure science. They rely on businesses that act as a proxies to perform the logistics of a trials as a proxy for the drug company trying to get their drug approved. The clinical trial facility gets paid by the drug company according to how many subjects they recruit. The greater the number of recruits, the more lucrative the business becomes.

How does one higher more recruits in the 2020s than they did in the 1970s? Advertising? Educating the public? I think that has a great deal to do with it. However, in order to increase the percentage of applicants accepted for a trial, the inclusion criteria have become broader in scope and allows for the acceptance of less severe presentations, many of which are actually symptoms of another diathesis (underlying cause) entirely. Should people with dysthymia be included in the study? What about an abnormally long bereavement period? All they need is to say, "I'm depressed". These subjects don't have the illness being studied. Therefore, the drug being investigated might actually be more effective than the trial facility reported. When people who don't have MDD fail to respond to the antidepressant being studied, the success rate will be greatly reduced.


What about the rate of placebo response? Why is it so much higher now than it was 35 years ago? First of all, "placebo" does not equal "no treatment". A subject usually gets supportive care in addition to the test drug. The U.S. National Institutes of Health found that most of their patients with depression report feeling better for about two weeks upon entering the clinical center building as an inpatient. However, the same principle operates with outpatients. The patient has gained hope that they will soon be relieved of their pain soon because they are being treated by professionals - perhaps for the first time. A patient's outlook is one of the most critical factors that determine a person's overall depressive condition. Having a brighter outlook early in the drug trial at the beginning of treatment is often accompanied with relief from feelings of doom. However, this is considered to be a placebo response if the test drug had not been administered.


1. 1960s / 1970s / 1980s
- Response Rate = 65-69%
- Placebo Rate = 15-25%

2. Today
- Response Rate = 46%
- Placebo Rate = 35-40%


"We identified 252 placebo-controlled trials (26 324 patients on placebo) done between 1978 and 2015. *THERE WAS A STRUCTURAL BREAK IN 1991, and since then, the average placebo response rates in antidepressant trials have remained constant in the range between 35% and 40%"

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30307-8/fulltext


The reported statistics presented here are facts. The hypothesis for why they changed is mine. You can go back to 2001 and read my thoughts on this subject. They were the same then as they are now. Finally, scientists acknowledge the differences in the historical response / placebo rates over the course of decades.

I recommend that you not give credence to people citing statistics gathered after 1990.

As I have so often argued with others here in the past, these drugs work. The disappointment is that no one person will respond to every drug sold. The nay-sayers of 2001 are now the ones taking standard antidepressants in 2024. Why?

I hope you understand why your story and conclusions are so important for others to read. You are right. These drugs work. These drugs save lives.

One thing to pay attention to is that biological psychiatry is now studying clinical and pharmacological properties of "non-standard" antidepressants. This includes psilocybin ("magic mushrooms") and ketamine. These substances are bound to have clinical profiles that are different enough from standard antidepressants to have different response rates. In my case, if I were to relapse or get diminishing returns from my currently effective treatment regime, I am looking at adding micro-dose psilocybin to my other medications.

Take care, Denise.


* I didn't have time to proofread this.


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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