Posted by mattdds on February 9, 2003, at 17:41:30
In reply to Re: Anti_depressants little more than placebos?, posted by Larry Hoover on February 9, 2003, at 17:13:31
Larry,
"Placebo groups in clinical trials are not untreated"
First, I don't wish to engage in a heated argument about this, and I am aware you are probably the most pharmacologically knowlegdable person who posts here.
Just one thing. I agree with you that placebo treatment is still treatment. The alliance with professionals in hopes of getting an effective treatment can affect one's mood. However, this is also true of people getting antidepressant treatment. So don't all these nonspecific treatment factors (e.g. therapeutic alliance, participating in a study, the simple act of taking a pill to try to help yourself) figure in to the AD group's response as well? How do we know that ALL of the benefit we are seeing is from the pharmacological effect? And if these "other" things figure in, doesn't that make the actual drug effect quite small? If they are somehow exempt from that effect, I'd like to know why.
But antidepressants do somewhat better, so isn't that something? Maybe. But it could also be an "unblinding effect", which I'm sure you've heard of. In other words the side effects are fairly obvious to most people, and it quickly becomes apparent who is taking what. This might very well skew the results. Why not use active placebos, like diphenhydramine or something with obvious anticholinergic effects.
My opinion is not totally formed about this topic, and I try to keep an open mind (really!), despite my bad luck with them. But I am pretty convinced there are some major flaws in AD trials.
Respectfully,
Matt
poster:mattdds
thread:140316
URL: http://www.dr-bob.org/babble/20030208/msgs/140334.html