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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 87 to 111 of 123. Go back in thread:
Posted by jhj on September 14, 2007, at 0:01:10
In reply to Re: STAR*D study, 33% sucess with first AD-sam123, posted by sam123 on September 13, 2007, at 8:31:15
I disagree with that point and will post what I like where I like.You have misunderstood me.I am not stoping you from making any point.I mentioned about the thread in which i mentioned the findiings of star*d study and the responses i got.I completely endorse the findings of the study and i wrote in lighter vein about not mentioning. it.I think it was one of the most comprehensive study ever conducted on depression.
Posted by jhj on September 14, 2007, at 0:04:57
In reply to Please follow board guidelines » jhj, posted by Deputy Racer on September 13, 2007, at 12:51:26
Please do not mention about STAR*D study here.You read the comments made on STAR*D study here in reponse to another thread.I wrote the thing only lightly if you read entire post.I have no problem with any study conducted by anybody and certainly about the study which is conducted on such large scale like star*d.I did not find it objectionable to mention the study at all. that is why i did not use the notify the administrator button.Thanks.
Posted by jhj on September 14, 2007, at 0:26:09
In reply to placebo vs. antidepressant, posted by Larry Hoover on September 13, 2007, at 13:51:57
I believe these conclusions to be unsupported by the available evidence. If these statements were true, what would we find when we looked at the placebo-controlled clinical trial data?
If we assume equivalence between an antidepressant drug and placebo, then under the statistical assumptions that govern what we call 'significance', 19 times out of 20, there would be no significant difference between the two experimental groups. When we look at all available clinical trial data, including all the studies that were never published, is this the case? No.
Under those same assumptions, assuming equivalence, both placebo and the antidepressant should have similar frequency of being found to be statistically superior to the other. Is this the case? No.
But there are other ways to look at the data. We can rank them, even those studies where significant superiority was not obtained. If equivalent, then placebo and the antidepressant should have a similar likelihood of being superior. Is that the case? No. Mean, median, t-test, I don't care how you look at it, antidepresants and placebo are not found to be equivalent.
I've previously argued that you cannot form conclusions about equivalence from obtaining null results in clinical trials. There are a number of reasons why that is so. One is that you cannot know if you conducted an otherwise valid study, but used the wrong subjects. Nor can you know from the results if your methodology was sound. Nor can you exclude chance. You don't know if there wasn't a difference to be found, only that you failed to find one, under the conditions employed. Again, the scientific aphorism, "The absence of evidence is not evidence of absence."
There is no disorder known to man that exhibits a more robust placebo response in clinical trials than does major depression. In a clinical trial you get validation, attention, a chance to be heard, empathy. So maybe some people do just need more love, and that's a big reason why they're exhibiting depression. For others, the difficulty might be more 'mechanical', i.e. biochemical in nature. Lumping both groups together in a clinical trial is going to dilute the effect of a biological intervention. It just stands to reason.
I am not saying it that placebo work as well as antidepressant.I am merely quoting from the one previous post to this same thread.
"but I can argue that placebos work as well as antidepressants in most clinical trials becuase that is fact based.
Linkadge"I am neither saying that placebo work as well as antidepressant nor am i saying that ADS incerase suicide risk.I am merely saying that if the statement i have quoted from previous post is assumed true then people should not be prescribed ADs.My belief is that ADs are more effective then placebos and they do not increase the suicide rates.
Posted by jhj on September 14, 2007, at 0:38:49
In reply to Re: STAR*D study, 33% sucess with first AD-sam123 » Larry Hoover, posted by linkadge on September 13, 2007, at 16:40:46
Sam,I have nothing against STAR*D study.I was just quoting link's view on star*d study.Now you can find them here too.
"Exactly, thats why I don't care for the STAR*d.
Linkadge"
Posted by Larry Hoover on September 14, 2007, at 8:52:21
In reply to Re: STAR*D study, 33% sucess with first AD-sam123 » Larry Hoover, posted by linkadge on September 13, 2007, at 16:40:46
> >The methodology for this study is entirely >different than that used for placebo-controlled >clinical efficacy trials.
>
> Exactly, thats why I don't care for the STAR*d.
>
> LinkadgeWhat troubles you about it?
Lar
Posted by Larry Hoover on September 14, 2007, at 9:15:44
In reply to Re: placebo vs. antidepressant, posted by sam123 on September 13, 2007, at 22:51:11
> >
> > Thought-provoking, all in all.
> >
> > Lar
> >
> >
>
> Emperor ? Clothes ?It strikes me that if placebo response is adversely influenced by e.g. flexible dosing, whereas antidepressant response is enhanced (and more like standard clinical practise, also), then we might actually find methodologies to strip away the artefact of clinical trial structure, and reveal the medication effect itself. Well, at least do a better job of it.
IMHO, depression is multifactorial in etiology. Even with a genetic predisposition, environmental factors are powerful modulators. Even if one assumes a purely biological depression, one would never lose one's humanity, i.e. responsiveness to personal attention, caring, support, and love.
In comparisons between studies, Khan (and many others, but I didn't reference them) discovered highly significant correlations between placebo response and antidepressant response. Both tended to be lower, or both tended to be higher. This covariance has the unfortunate mathematical effect of obscuring the drug effect in the more responsive trial environments, despite findings overall that more people found remission.
The gender bias towards placebo response in women also surprised me. I can think of sociological explanations, such as persistance of the dismissive treatment of women from earlier times (now more subtly applied, I'd imagine), or differential response to social cues.
The bias towards selecting moderately depressed subjects with no comorbid conditions actually predisposed towards placebo responsiveness.
The overall point is that everyone is concluding the drugs don't work, without considering the effects of the methodology. We don't know the effects of the methodology, but those effects are non-zero, and always act to obscure the true medication effect. They diminish our ability to see the truth.
Lar
Posted by sam123 on September 14, 2007, at 9:40:46
In reply to Re: placebo vs. antidepressant » sam123, posted by Larry Hoover on September 14, 2007, at 9:15:44
>
> The overall point is that everyone is concluding the drugs don't work,What saddens me is again and again people have posted in this tread and others about their successes, some long term, with AD's and other psycomeds. This seems to be falling on death ears and we have to resort to agruing about studies and methodology despite have proof right here that
at least from some these drugs are no placebos.
Posted by rskontos on September 14, 2007, at 11:05:17
In reply to Re: placebo vs. antidepressant, posted by sam123 on September 14, 2007, at 9:40:46
In my humble opinion, and I am only going on my experience, if I had been in the clinical trials, at the beginning I would have said the AD or whatever I was taking was working because at first it made me feel better than I was feeling at that point but over time, the effects wore off. So my overrall conclusion was that particular AD did not work. Now did it always not work and did I assume it worked because I wanted it too because I was so tired of feeling bad, perhaps, was I in a suggestive mind set because the doctor said this drug works well and in my mind I set great store by her in my faith in her to provide something to work, maybe. I wanted to get better and fast. Whatever the case maybe be and a placebo may have made me feel better at that particular time too because I wanted it badly, I was so low and hurting. She listened too. No one else was. I never trusted anyone too. This was the first time I asked for help too. I have asked myself all these questions while reading this thread, I might have gotten initally better on a placebo or AD at first but it wasn't maintained and then I got worse. So I concluded that the AD did not work. I think AD's work for some, I have friends on them and they have been on them for years and have tried many. So I guess they work for them. I do believe each body handles things diffferently as I can take certain pain meds and they do nothing regardless how many I take. Why I can't guess. I have tried many different migraine meds over the years and take one most people can't take so I draw the conclusion that drugs must work differently in different people. Thanks for education and the thought provoking discussion. RK
Posted by fuzz54 on September 14, 2007, at 12:17:46
In reply to Re: News - Antidepressants Vindicated?, posted by linkadge on September 9, 2007, at 12:21:58
> >Anti-depressants work for many depressed people. >Thus anti-depressants reduce the risk of suicide.
>
> Placebos work for many people too.
>
> LinkadgeI was told by my therapist (who is now a doctor doing psych research) that the placebo effect can be very real in the short-term but loses its effectiveness over the long-term. Anyone ever see any studies on this?
As for SSRIs being compared to placebos in effectiveness, I've been on some SSRIs that did nothing for me and some that helped quite a bit. I didn't have any special knowledge that made me expect some SSRIs to work and some to not work. For my specific case this leads me to conclude that SSRIs work better than placebo, however I am willing to concede that there are many factors at work in determining if someone will respond to an SSRI better than placebo. Maybe I'm just lucky.
fuzz
Posted by linkadge on September 14, 2007, at 13:59:12
In reply to Re: STAR*D study, 33% sucess with first AD-sam123 » linkadge, posted by Larry Hoover on September 14, 2007, at 8:52:21
>What troubles you about it?
No placebo arm.
Thats what little there is left to keep serious dogma in check.
Linkadge
Posted by linkadge on September 14, 2007, at 14:12:54
In reply to Re: placebo vs. antidepressant, posted by rskontos on September 14, 2007, at 11:05:17
Placebos aren't the only things to loose effectiveness over time.
Antidepressant "poop out" is being studied more and more.
Thats probably the biggest complaint we have here: "such and such a drug worked, and now it no longer works".
Tollerance to a pharmachological effect is one possability, loss of placebo effect is another.
Linkadge
Posted by sam123 on September 14, 2007, at 14:16:48
In reply to Re: placebo vs. antidepressant, posted by linkadge on September 14, 2007, at 14:12:54
> Placebos aren't the only things to loose effectiveness over time.
>
> Antidepressant "poop out" is being studied more and more.
>
> Thats probably the biggest complaint we have here: "such and such a drug worked, and now it no longer works".
>
> Tollerance to a pharmachological effect is one possability, loss of placebo effect is another.
>
> Linkadge
In the 20+ yrs I have been taking AD's I pooped out twice, and then found another med or combo that works just as well. I seem to poop out around the 10 yr mark.
Posted by linkadge on September 14, 2007, at 14:24:56
In reply to Re: News - Antidepressants Vindicated? » linkadge, posted by fuzz54 on September 14, 2007, at 12:17:46
>I was told by my therapist (who is now a doctor >doing psych research) that the placebo effect >can be very real in the short-term but loses its >effectiveness over the long-term. Anyone ever >see any studies on this?
This is kind of an unsubstantiated argument.
The bulk of antidepressant data is on trials that are done for such a short period of time. The drug company only needs to show that a drug is better than placebo for a number of weeks. How then do we really know if antidepressants outperform placebo in the long run? How do we even know that antidepressants "work" in the long run? We don't. There is a severe lack of good long term trial data.
The statment "only the true antidepressant effect will stand the test of time", can be used any way you like!
For instance, when an antidepressant poops out, some would argue (conviently) that there was no "true" responce to begin with so there really can be no "poop out". Ie, it is possable to have a placebo responce to an active drug.
Then its kind of a free for all.
Linkadge
Posted by linkadge on September 14, 2007, at 14:29:33
In reply to Re: placebo vs. antidepressant, posted by sam123 on September 14, 2007, at 14:16:48
>In the 20+ yrs I have been taking AD's I pooped >out twice, and then found another med or combo >that works just as well. I seem to poop out >around the 10 yr mark.
There are other possabilities. You may have just been well for a period of time while you were taking a particular drug, and that you got sick again around the 10 year mark.
Linkadge
Posted by sam123 on September 14, 2007, at 14:38:31
In reply to Re: placebo vs. antidepressant, posted by linkadge on September 14, 2007, at 14:29:33
>
> There are other possabilities. You may have just been well for a period of time while you were taking a particular drug, and that you got sick again around the 10 year mark.
>
> Linkadge
>You can always explain away anything but the only remissions I have experienced were med induced.
Far too many PITA HMO's that made me go without meds for a period; I crash quite quickly.
Posted by rskontos on September 14, 2007, at 15:23:54
In reply to Re: placebo vs. antidepressant, posted by sam123 on September 14, 2007, at 14:38:31
OK, assuming they didn't work then would there be any withdrawals from the drugs. Can you concluded that the drug is working if when you withdraw from it there are withdrawals or is that a different can of worms?
Posted by sam123 on September 14, 2007, at 15:39:41
In reply to Re: placebo vs. antidepressant, posted by rskontos on September 14, 2007, at 15:23:54
I do have problems with withdrawls, never have, Effexor gave me some discomfort for a day at best.
I was on Effexor for 10 yr, I did not have problems when I missed a dose.
Posted by ttee on September 14, 2007, at 19:00:59
In reply to Re: News - Antidepressants Vindicated? » fuzz54, posted by linkadge on September 14, 2007, at 14:24:56
Link - Didn't they do longer term (12 months) studies on Effexor, and Emsam? I thought that they ran the studies out 12 months and randomized the active group with placebos to see if they relapsed.
> >I was told by my therapist (who is now a doctor >doing psych research) that the placebo effect >can be very real in the short-term but loses its >effectiveness over the long-term. Anyone ever >see any studies on this?
>
> This is kind of an unsubstantiated argument.
>
> The bulk of antidepressant data is on trials that are done for such a short period of time. The drug company only needs to show that a drug is better than placebo for a number of weeks. How then do we really know if antidepressants outperform placebo in the long run? How do we even know that antidepressants "work" in the long run? We don't. There is a severe lack of good long term trial data.
>
> The statment "only the true antidepressant effect will stand the test of time", can be used any way you like!
>
> For instance, when an antidepressant poops out, some would argue (conviently) that there was no "true" responce to begin with so there really can be no "poop out". Ie, it is possable to have a placebo responce to an active drug.
>
> Then its kind of a free for all.
>
> Linkadge
>
>
>
>
>
Posted by jhj on September 15, 2007, at 2:17:03
In reply to Re: placebo vs. antidepressant, posted by linkadge on September 14, 2007, at 14:29:33
"There are other possabilities. You may have just been well for a period of time while you were taking a particular drug, and that you got sick again around the 10 year mark.Linkadge"
Fantastic argument.You seem to have some deep rooted problems against pharma companies working in the field of antidepressants.It is a challenge to those posters' intelligence who say they have benefited from antidepressants to say that they all have improved because of faith in treatment and not due to antidepressant effect of meds.When 7 out of 10 people come and say that they have improved after taking antidepressants i think it is better to believe them rather then getting obsessed about "placebo arm".And also you are implying throughout the thread that the studies,articles and sites quoted by you are "decent" and "unbiased" and those quoted by others are biased.Anyway,i request you to keep on arguing because it is providing uninterrpted entertainment though probably this site is not meant for that.I admire it because i know you arguing to make depressed people to have some fun and you are not serious at all.Am i right?
Posted by linkadge on September 15, 2007, at 8:21:45
In reply to Re: placebo vs. antidepressant, posted by rskontos on September 14, 2007, at 15:23:54
You can have withdrawl from a caffiene, that doesn't mean it was affecting your depression.
Linkadge
Posted by linkadge on September 15, 2007, at 8:23:49
In reply to Re: News - Antidepressants Vindicated?, posted by ttee on September 14, 2007, at 19:00:59
Yes, I think there are a limited number of long term trials on venlafaxine. I *personally* think those studies would be highly biased.
Setting up an expensive short term trial that fails is one thing.
In addition, we simply need *more* of them.
Linkadge
Posted by linkadge on September 15, 2007, at 8:27:56
In reply to Re: placebo vs. antidepressant, posted by jhj on September 15, 2007, at 2:17:03
>You seem to have some deep rooted problems >against pharma companies working in the field of >antidepressants.
Nothing of the sort. I am just posing possabilities that some researchers have sugested.
>It is a challenge to those posters' intelligence >who say they have benefited from antidepressants >to say that they all have improved because of >faith in treatment and not due to antidepressant >effect of meds.
That is incorrect too. The placebo effect has been studied intensivly. It is not a product of unintellegence.
>When 7 out of 10 people come and say that they >have improved after taking antidepressants i >think it is better to believe them rather then >getting obsessed about "placebo arm".
I disagree. If 7 out of 10 people had correspondingly responded to a placebo in the same study, then the presence of the placebo arm is highly meaninful, and indispensable.
I can only agree with the line of logic "as long as the patient is happy thats all that matters" so much.
Linkadge
Posted by Larry Hoover on September 15, 2007, at 9:50:20
In reply to Re: News - Antidepressants Vindicated? » linkadge, posted by fuzz54 on September 14, 2007, at 12:17:46
> > >Anti-depressants work for many depressed people. >Thus anti-depressants reduce the risk of suicide.
> >
> > Placebos work for many people too.
> >
> > Linkadge
>
> I was told by my therapist (who is now a doctor doing psych research) that the placebo effect can be very real in the short-term but loses its effectiveness over the long-term. Anyone ever see any studies on this?If someone could get a full-text of this article, we might have the evidence laid bare:
J Clin Psychopharmacol. 2007 Apr;27(2):177-81.
Impact of study design on the results of continuation studies of antidepressants.
Zimmerman M, Posternak MA, Ruggero CJ.
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA. mzimmerman@lifespan.orgAntidepressant continuation studies have used 2 different designs. In the placebo substitution design, all patients are initially treated with active medication in an open-label fashion, and then treatment responders are randomized to continue with medication or switch to placebo in a double-blind manner. In the extension design, patients are randomized to a double-blind placebo-controlled acute study at the outset, and responders to active treatment and placebo are continued on the treatment to which they initially responded. We hypothesized that the design of antidepressant continuation studies would impact on the likelihood of relapse. In the extension design, there is no change in treatment. Whether patients responded to placebo or medication, the treatment that produced the response is continued. In contrast, in the placebo substitution design, there is an obvious change in treatment protocol upon initiation of the continuation phase. Patients are aware that they initially received active medication, and there is now a chance that they will be switched to placebo. We speculated that the expectation of a continued positive response is lower in patients treated using the placebo substitution design than the extension design and therefore predicted that relapse rates would be higher. We conducted a meta-analysis of antidepressant continuation studies and compared the relapse rates in continuation studies using these 2 different designs. As predicted, for both the active medication and placebo groups, the frequency of relapse was lower in studies using an extension design. We also found that the difference in relapse risk between antidepressants and placebo was greater with the extension design. Thus, the design of continuation studies of antidepressants was associated with the absolute percentage of patients who relapse on both active medication and placebo, as well as estimates of differential relapse risk between antidepressants and placebo.
Posted by jhj on September 16, 2007, at 2:04:56
In reply to Re: News - Antidepressants Vindicated? » ttee, posted by linkadge on September 15, 2007, at 8:23:49
In addition, we simply need *more* of them.
Why do you want to have more long term studies of venlafaxine or any other ADs when facts have establish according to you that placebo work as well as antidepressant? Why should people waste money,time and their energy by conducting more long term trials when it is already known that venlafaxine is no better then placebo?
Posted by jhj on September 16, 2007, at 2:17:49
In reply to Re: placebo vs. antidepressant » jhj, posted by linkadge on September 15, 2007, at 8:27:56
It is not a product of unintellegence.
I am not suggesting you are saying any unintelligent thing.i am saying that you think those posters who claim that they have benefited by use of Antidepresants are naive and unintelligent You are saying 7 out of 10 people who say they have improved despite being given only dummy pill can be misled easily.So,i think i should assume fake identity of a psychiatrist and start distributing dummy pills to patients of depression and i can be as successful as qualified pdoctors because the improvement reported by their patient would not be better then those of mine.In fact,with claver and shrewd publicity i can be more successful then qualified psychiatrists by augmenting the effect of faith in medicines with faith in my ability too as psychiatrist and i would be able to give better results then many of them.
I *personally* think those studies would be highly biased.
You always *personally* think that those sites,links,articles and studies quoted which go against your point of view are highly biased and those supporting your view point are decent and unbiased.I am not saying you are saying anything illogical.I am merely saying that my level is not high enough to understand the logic.
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