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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Larry Hoover on February 1, 2007, at 10:31:41
Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacological Treatment of Adult Depression (January 2007)
http://effectivehealthcare.ahrq.gov/repFiles/Antidepressants_Final_Report.pdf
To skip the gobbledygook, go to Bookmarks/Discussion/General Conclusions.
Lar
Posted by blueberry1 on February 1, 2007, at 16:54:34
In reply to Report: Comparative Effectiveness of Antidepres..., posted by Larry Hoover on February 1, 2007, at 10:31:41
That's too much to read and I am too dysphoric to read right now. What were some of the key points of the report?
Posted by Phillipa on February 1, 2007, at 23:22:39
In reply to Re: Report: Comparative Effectiveness of Antidepres..., posted by blueberry1 on February 1, 2007, at 16:54:34
Lar just home from a long drive to pdocs will read in am. Love Phillipa
Posted by mindevolution on February 2, 2007, at 1:29:35
In reply to Re: Report: Comparative Effectiveness of Antidepres... » blueberry1, posted by Phillipa on February 1, 2007, at 23:22:39
key question 2a page 23 of 167: efficacy and effectiveness of sgad for maintaining response or remission? (i.e preventing relapse or reoccurence)
what?! they prevent depression from occurring??? how can they claim this, on what basis do ADs operate as vaccines for conditions they can't even cure. what a ridiculous concept!
do psychopharmaceutials operate completely outside the rules of ordinary medicine?
but the drug companies make loads more money if people think they are preventing a "disease" from occurring by taking "medicine". they do not know what causes depression, as a consequence they cannot cure it nor prevent it from occurring. they can only try and reduce the symptoms of it, like cold medication!
do you take cold medication for the rest of your life just because you may get a cold again??????
some people are depressed all the time, and these people may need to take AD on a long term basis. but the concept of preventative medicine with mental illness is ridiculous!
me
Posted by mindevolution on February 2, 2007, at 1:55:27
In reply to Re: Report: Comparative Effectiveness of Antidepres..., posted by mindevolution on February 2, 2007, at 1:29:35
severe adverse events on page 26 of 167
there is no data for suicide, seizures or cardiovascular events or any other severe adverse event! what is going on with that study, is it sponsored by all the drug companies combined?
from pages 60 - 73 they always suggest there is no difference between most of the ADs! the ADs vary significantly in chemical structure, something smells a bit about all the "meta analysis" going on.
on page 74, the graph showing the summary shows that the only drug that is persecuted by the study is fluvoxamine which has been discontinued as a brand in the US! by chance, no way!
me
Posted by mindevolution on February 2, 2007, at 2:05:50
In reply to Re: Report: Comparative Effectiveness of Antidepres..., posted by mindevolution on February 2, 2007, at 1:55:27
I stopped reading at p75, i suspect drug company involvement to the point of it being a waste of time reading the document.
all we really need is proper independent drug testing, not summaries of drug trials paid for by the drug companies themselves.
so a company wants a new AD approved, it gives the government 20 million to test it independently, easy as that. how hard can it be?! shame on the government, the fda and the drug companies.
me
Posted by psychobot5000 on February 2, 2007, at 13:09:50
In reply to Re: Report: Comparative Effectiveness of Antidepres..., posted by mindevolution on February 2, 2007, at 1:29:35
> key question 2a page 23 of 167: efficacy and effectiveness of sgad for maintaining response or remission? (i.e preventing relapse or reoccurence)
>
> what?! they prevent depression from occurring???
It's based on evidence that continuing to take an antidepressant after remission prevents relapse in a statistically significant portion of patients, as compared with placebo. Moderate efficacy in this regard seems to be born up by most of the results I've seen.We indeed don't seem to know what causes depression, but that doesn't mean we don't have tools that can keep many patients from relapsing.
...I saw little of use in this report. No distinctions for using any drug type for any sypmtom-clusters, and few variations in efficacy. Notable is that mirtazapine/remeron seems to have a significantly faster onset of action. Not much else.
Posted by Larry Hoover on February 3, 2007, at 8:43:36
In reply to Re: Report: Comparative Effectiveness of Antidepres..., posted by mindevolution on February 2, 2007, at 2:05:50
The type of report referenced here is the result of a very conservative methodology. By definition, it excludes the bulk of all published research or reports, based on clearly defined criteria that are laid out on page 41. In total, 2,099 citations were identified, but they ultimately included 293 in the final detailed analysis. See the discussion on page 46, and the diagram on page 47.
> key question 2a page 23 of 167: efficacy and effectiveness of sgad (sic) for maintaining response or remission? (i.e preventing relapse or reoccurence)
> what?! they prevent depression from occurring???
The subject is clearly expressed on page 33. In fact, this report is the first evidence-based analysis which assesses long-term outcomes in this manner. That's why I thought it worthwhile to post the link.
> severe adverse events on page 26 of 167
> there is no data for suicide, seizures or cardiovascular events or any other severe adverse event! what is going on with that study, is it sponsored by all the drug companies combined?
No. Nothing of the sort. In an evidence-based analysis, the quality of the data made available is also assessed. I would paraphrase the conclusions expressed as: "There is little available data, and the data published are of insufficient quality to make firm conclusions."
The methodology excludes case reports, or other anecdotal evidence. Absent any control subjects, it is impossible to analyze such cases by statistical means.
Clearly, the published data do not adequately address concerns vis a vis adverse events. That is not the fault of these authors.
> from pages 60 - 73 they always suggest there is no difference between most of the ADs! the ADs vary significantly in chemical structure, something smells a bit about all the "meta analysis" going on.
Frankly, I find the statistical analysis in this section to have been superbly done. Moreover, I cannot find even a hint of bias in the entire report.
> on page 74, the graph showing the summary shows that the only drug that is persecuted by the study is fluvoxamine which has been discontinued as a brand in the US! by chance, no way!
I'm not exactly sure what you're driving at. Fluvoxamine did seem to be the underdog in comparator studies. I think that might be a relevant detail. If I recall correctly, it is often preferred for treatment of PTSD. I was unaware of the branding issue. It is still marketed, though, isn't it?
> I stopped reading at p75, i suspect drug company involvement to the point of it being a waste of time reading the document.
The research authors all had no drug company connections. All documents were accessed from publicly available resources, except 3 articles supplied by drug companies. (page 40)
I too condemn the publication bias arising from private funding of the bulk of pharmaceutical research. Roughly 2/3 of the documents considered in this study had direct pharmaceutical company funding. In more than 20% of the cases, funding could not be determined. Only 6.7% were funded by government.
This published review could only consider the literature extent. It would be of great public service to require Phase IV reviews for all drugs. Unfortunately, we cannot make up for the lost historical opportunities to have done so. The drug review process is constantly evolving. It was not so very long ago that a drug could be developed and marketed without any oversight whatsoever.
Lar
Posted by Larry Hoover on February 3, 2007, at 8:45:56
In reply to Re: Report: Comparative Effectiveness of Antidepres..., posted by blueberry1 on February 1, 2007, at 16:54:34
> That's too much to read and I am too dysphoric to read right now. What were some of the key points of the report?
Ummmm, maybe if you skimmed the executive summary, starting on page 14?
There is nothing dramatic being revealed.
Lar
This is the end of the thread.
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