Posted by BrittPark on September 27, 2002, at 21:01:24
In reply to Re: Antidepressants versus placebo smackdown!, posted by Mr. SadPuppyDog on September 27, 2002, at 11:32:52
> The biggest problem with antidepressant drug clinical trials in the USA is the fact that new ADs are not tested on those with "severe" depression. Most of the people recruited into antidepressant clinical trials are those with mild depression (dysthymia) to moderate depression. Those with severe depression, such as those with melancholia features such as severe insomnia, losing large amounts of weight, severe loss of sex drive and function and severe cognitive decline are generally avoided in AD drug trials.
>
> This leads to the so called "placebo" effect which many in the mental health field constantly talk about. Since many with mild to moderate depression arent really depressed in the TRUE sense of the word, they get a few side effects and get disgusted and quit. Or there depression is so mild, so about anything makes them "undepressed."
>
> We'd read and hear much less about the antidepressant "placebo" response if more AD drug trials purposely recruited those with severe depressions. I also believe that many of the current drugs wouldnt even be FDA approved if these drugs were held up to the higher standards of creating a full remission in those with severe depression.
>
> Such talk however is a pipe dream pretty much though, as the drug companies realize that there are many more with mild to moderate depression...thus a bigger market for antidepressants in this demographic area. So we end up with SSRIs that dont work good for severe depression and other "me too" drugs, like Lexapro which are about useless for anything other than dysthymia.
>
> The placebo effect is a lie and frankly, Im sick of reading about it.
>
>
> Mr. Sad PuppyDog
I think you are right about a number of things in what you've said, but have come to the wrong conclusion. Clinical studies of AD effectiveness do tend to attract less severely depressed patients but it's not all the researchers' fault. Clinical studies are self-selecting. If you were suffering a crippling episode of depression would you take part in a clinical study? Most people would not; they'd rather see a psychiatrist and get the best possible treatment rather than risk being in the placebo group.There are instances of studies in which severely depressed patients have been the subjects. (I can't give you citations off the top of my head.) In these studies the difference between placebo and drug (if its a good drug) have been greater, and the response to medication has been greater in terms of reduction in HAM-D etc. One study in particular compared severely depressed patients on ADs (probably an SSRI), Cognitive Behavioral Therapy, and placebo, and found that CBT was statistically no better than placebo while ADs were significantly better than placebo. (I don't intend to diss CBT. It has it's place and has been shown to be effective for milder depressions.) So I think I disagree with your conclusion that most AD are not effective. I think most ADs are more effective than many of the clinical studies would suggest.
poster:BrittPark
thread:120924
URL: http://www.dr-bob.org/babble/20020922/msgs/121318.html