Posted by Klavot on July 15, 2006, at 7:32:31
In reply to Re: couldn't have said it better myself, posted by SLS on July 15, 2006, at 7:27:24
The actual paper of the controversial Zoloft / St John's Wort study can be found at http://jama.ama-assn.org. Restricted membership to JAMA is free, and I would strongly encourage anybody interested in psychotropic medication to read this paper. Taken in its entirety, it gives a rather more positive depiction of Zoloft than the frequently pandered claim that Zoloft has no super-placebo efficacy. A few pertinent points:
1. Some critics have said that the placebo success rate in this study was unusually high, that in other similar studies (similar in terms of duration, patient profile etc.) the placebo remission rate is often much lower. So perhaps the placebo success rate in this particular study is a statistical aberration.
2. The average dose of Zoloft used was relatively low (75 mg / day during the acute phase and 89 mg / day during the maintenance phase) especially considering that the mean 17-point HAM-D score for the Zoloft arm was a relatively high 22.5.
3. Patients with a HAM-D suicide score of more than 2 were excluded for ethical reasons. The role of low serotonergic activity in suicidal ideation is well correlated. Had these patients been included in the study, this would likely have improved the outcome of the Zoloft arm relative to placebo.
4. While Zoloft did not differ to a statistically significant extent from placebo in producing full remission, the case of strictly partial remission is another story. Zoloft produced strictly partial remission in some 26 % of patients compared to the 13 % placebo rate.
5. Zoloft had an overall higher response rate than placebo (46 % Zoloft vs 36 % Placebo).
6. Zoloft gave a greater improvement in mean HAM-D, GAF, BDI, SDS and CGI scores than placebo, admittedly not all of them statistically significant.
7. 22 % of placebo patients reported "forgetfulness", compared with 12 % Zoloft patients. Thus it may be that, on average, Zoloft actually improves memory (this has certainly been my personal experience).
8. As far as I can tell, all the authors of the study have financial interests in Pfizer.
Vitamin Z has vindicated itself in my book!
Klavot
poster:Klavot
thread:662854
URL: http://www.dr-bob.org/babble/20060709/msgs/667231.html