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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by linkadge on December 29, 2006, at 11:22:29
A small blurb from:
http://www.namiscc.org/newsletters/February02/McMan4-10.htm
AFTER THE HYPEAccording to a Health Media article, the Royal College of Psychiatrists in the UK has altered advice stating that Prozac and other leading antidepressants "are effective in 60 to 70 per cent of patients, to saying the drugs are successful in only 50 per cent of cases."
Linkadge
Posted by Bob on December 29, 2006, at 11:59:03
In reply to After the hype, posted by linkadge on December 29, 2006, at 11:22:29
> A small blurb from:
>
> http://www.namiscc.org/newsletters/February02/McMan4-10.htm
>
>
> AFTER THE HYPE
>
> According to a Health Media article, the Royal College of Psychiatrists in the UK has altered advice stating that Prozac and other leading antidepressants "are effective in 60 to 70 per cent of patients, to saying the drugs are successful in only 50 per cent of cases."
>
> Linkadge
>
Things like this are showing up more and more in the news, and I suspect even the "50%" statement is overly optimistic if you include long term treatments, and people who actually admit nasty side effects they are putting up with.I recently read a newspaper article stating that the atypical antipsychotics are becoming quite problematic, and are seemingly sometimes no better than placebo in some cases. Of course, there are two sides to all these issues.
Posted by laima on December 29, 2006, at 12:23:37
In reply to Re: After the hype » linkadge, posted by Bob on December 29, 2006, at 11:59:03
I noticed that a lot of drug studies conclude with something like, "Drug is more effective than placebo". Is that all it takes to get approved and on the market- being more effective than a placebo?
Posted by Klavot on December 29, 2006, at 12:24:17
In reply to After the hype, posted by linkadge on December 29, 2006, at 11:22:29
The antidepressants information website (updated December 2006) of the Royal College of Psychiatrists, see
states
"After 3 months of treatment, the proportions of people with depression who will be much improved are:
50% and 65% if given an antidepressant
compared with
25 - 30% if given an inactive "dummy" pill, or placebo"so perhaps the article is not entirely accurate.
Klavot
> A small blurb from:
>
> http://www.namiscc.org/newsletters/February02/McMan4-10.htm
>
>
> AFTER THE HYPE
>
> According to a Health Media article, the Royal College of Psychiatrists in the UK has altered advice stating that Prozac and other leading antidepressants "are effective in 60 to 70 per cent of patients, to saying the drugs are successful in only 50 per cent of cases."
>
> Linkadge
>
Posted by Phillipa on December 29, 2006, at 18:12:22
In reply to Re: After the hype, posted by Klavot on December 29, 2006, at 12:24:17
So what happens to the rest of the people that do not respond? Love Phillipa
Posted by blueberry1 on December 29, 2006, at 18:17:16
In reply to After the hype, posted by linkadge on December 29, 2006, at 11:22:29
I think the TRUE measure of antidepressant efficacy...REMISSION...RETURNING TO ONE'S FORMER SELF... would make the numbers go way down. Unfortunately they don't rate antidepressants that way. Instead they usually use 50% improvement. 50%? That sucks. Or sometimes they use 'much improved' or 'very much improved'. But even then, that is not the same as remission. Define efficacy by remission and I bet the success percentage would drop to about 10% to 20%. Just a guess.
Posted by linkadge on December 29, 2006, at 19:08:36
In reply to Re: After the hype, posted by blueberry1 on December 29, 2006, at 18:17:16
Thats true. Anyone can just "respond". If it does anything at all, you have responded.
Linkadge
Posted by Phillipa on December 29, 2006, at 20:01:32
In reply to Re: After the hype » blueberry1, posted by linkadge on December 29, 2006, at 19:08:36
What if you don't respond don't they understand that the more horrific experiences the less likely you are to try another med? Love Phillipa
Posted by med_empowered on December 29, 2006, at 22:46:20
In reply to Re: After the hype » linkadge, posted by Phillipa on December 29, 2006, at 20:01:32
wow..finally, an admission from the powers-that-be that Antidepressants really aren't all they're cracked up to be. The indications have been there for *YEARS*--Healy and others have long been saying that these drugs often fail to outperform placebo and that they're at most modestly useful drugs, and then only really useful in carefully selected patients. And yet...billion$ have been spent on these meds that could have been spent on other meds (stimulants, benzos, anticonvulsants), therapy, nutritional approaches, or...fighting hunger, poverty, etc. Its pretty ridiculous.
Anyway...maybe now shrinks will finally move on, and maybe listen to their patients this time. But probably not. If the pattern holds, what will happen is a quiet admission of less-than-stellar results, followed by a strong denunciation of these drugs once something newer and more expen$ive comes out, followed by a reconsideration of their virtues and efficacy (look at the pattern with neuroleptics).
Posted by Klavot on December 30, 2006, at 3:29:57
In reply to Re: After the hype » blueberry1, posted by linkadge on December 29, 2006, at 19:08:36
> Thats true. Anyone can just "respond". If it does anything at all, you have responded.
>
> LinkadgeI have never experienced full remission from an antidepressant, only partial, but I have always been grateful for that, since being slightly depressed sure beats feeling suicidal. In fact, full remission - presumably not having any symptoms of depression at all - is in my opinion an urealistic expectation to have of psychotropic medication. People who search for this elusive perfect cocktail of drugs that will make them feel perfect will only frustrate themselves, because it does not, and never will, exist.
Klavot
Posted by madeline on December 30, 2006, at 6:34:45
In reply to Re: After the hype, posted by laima on December 29, 2006, at 12:23:37
Actually, we are lucky now that some efficacy has to be demonstrated.
The FDA used to only care if the drug was safe and left it up to the providers to determine efficacy.
Posted by linkadge on December 30, 2006, at 10:02:57
In reply to Re: After the hype » laima, posted by madeline on December 30, 2006, at 6:34:45
More than half of all clinical trials fail to show that antidperessants perform better than placebo.
So, if you really want accurate numbers for clinical trials, you do it this way.
More than half fail to show, that means that less than half actually show, say 42%. Then we multiply that by the average number of people helped *within* a successfull clinical trial, say 55%.
Ie clinical trials, overall, say that 0.42 x 55% = 23% of people are helped by antidepressants.
But they don't do that. They simply state the percentage of people who are helped within sucessfull clinical trials.
Linkadge
Posted by Klavot on December 30, 2006, at 11:32:37
In reply to Re: After the hype, posted by linkadge on December 30, 2006, at 10:02:57
No, the calculation is wrong; it assumes that 58% of trials find a 0% success rate for antidepressants.
Suppose, as you do, that 42% of trials find antidepressants to work for 55% of patients, and the remaining 58% of trials find antidepressants to work at placebo level - say for argument sake 40% success rate.
Then the overall proportion of patients who will benefit from antidepressants is
0.42 x 0.55 + 0.58 x 0.40 = 0.463
or 46.3% (assuming the given data).
Klavot
> More than half of all clinical trials fail to show that antidperessants perform better than placebo.
>
> So, if you really want accurate numbers for clinical trials, you do it this way.
>
> More than half fail to show, that means that less than half actually show, say 42%. Then we multiply that by the average number of people helped *within* a successfull clinical trial, say 55%.
>
> Ie clinical trials, overall, say that 0.42 x 55% = 23% of people are helped by antidepressants.
>
> But they don't do that. They simply state the percentage of people who are helped within sucessfull clinical trials.
>
> Linkadge
>
>
>
Posted by linkadge on December 30, 2006, at 17:38:33
In reply to Re: After the hype » linkadge, posted by Klavot on December 30, 2006, at 11:32:37
I see your logic.
Although, I think my reasoning was even more flawed in that you would never have a certain percentage of trials showing a specific sucess rate. In fact it would be hard to find any two trials that show the exact same sucess rate.
In addition, this method only works if one assumes that each clinical trial has the same number of people in it. So even saying that more than 50% of trials fail doesn't say much, as the failed trials might have significantly fewer participants than the trials that are sucessfull (ie it should be weighted towards the sucessfull trials)
I'm just going to try and forget what I've started here :)
Ie. I don't think you can find the percentage of people helped by antidepressants without knowing the exact number of people helped and not helped in each clinical trial.
If you wanted to go into even more detail you could factor in the degree to which each person felt they were helped :)
I'll shut up now.
Linkadge
Posted by Klavot on December 31, 2006, at 11:27:14
In reply to Re: After the hype, posted by linkadge on December 30, 2006, at 17:38:33
> Ie. I don't think you can find the percentage of people helped by antidepressants without knowing the exact number of people helped and not helped in each clinical trial.
>
> If you wanted to go into even more detail you could factor in the degree to which each person felt they were helped :)
>
> I'll shut up now.
>
> Linkadge
>
>I think that's what they do in a "meta-analysis" - they come up with a grand total success rate from analysing a large body of appropriately weighted existing trials.
I'll shut up as well now :)
Klavot
Posted by Karen44 on December 31, 2006, at 18:15:07
In reply to After the hype, posted by linkadge on December 29, 2006, at 11:22:29
And so what does one do when none of antidepresants from all of the classes of antidepressants works to even bring one to a mild to moderate depression. What is left??
Karen44
Posted by Phillipa on December 31, 2006, at 19:14:04
In reply to Re: After the hype, posted by Karen44 on December 31, 2006, at 18:15:07
That is my question too. Can anyone answer it? Love Phillipa
Posted by linkadge on December 31, 2006, at 20:14:35
In reply to Re: After the hype » Karen44, posted by Phillipa on December 31, 2006, at 19:14:04
As long as people believe they work, thats all that matters.
They worked for me at first, before I knew that they didn't work. As soon as I knew that they didn't work, they no longer worked.
Linkadge
Posted by Reggie BoStar on January 1, 2007, at 10:15:28
In reply to Re: After the hype, posted by linkadge on December 31, 2006, at 20:14:35
Hi Linkadge,
I wonder if the new stats have anything to do with the fact that the infamous "poopout" is showing up more and more as the years go by.About two years ago, my pdoc suggested that I contact one of his colleagues who was doing a medication study. When I met the guy, it turned out that what they were doing was trying a new med to see if it could augment Prozac to make it last longer. I stood down for two reasons:
1. I asked him why the behavioral health community had this love affair with Prozac. I phrased it just like that. I told him it was obvious that even when it worked, it had no staying power. Why, I asked, after all these years of playing with Prozac in different combos to try to get some positive result, don't you guys just stop wasting time with it and try something new? He at least agreed that there was a problem with Prozac's staying power for "many people".
2. This has nothing to do with the topic, really, but there is an interesting factum in it. He told me that placebos would be used in the trial, and that I would not know whether or not I was being given the placebo. I told him that placebos don't work on me, because I go into these studies autmatically assuming - and believing - that the drug won't work. Therefore placebos can't fool me into thinking that they do work.
Now here's the interesting part. He suggested that my sort of attitude could also have a negative effect on how the real drugs works.
What??!???
I told him that if a bad attitude was all it took to nullify the effects of Prozac, then Prozac was worth no more than a placebo. Would a bad attitude keep morphine from working? No way. That's the difference between a drug that really works and one that doesn't.
Anyway, that's my two cents for the New Year.
Take care everyone,
Reggie BoStar
Posted by linkadge on January 1, 2007, at 20:45:40
In reply to Re: After the hype, posted by Reggie BoStar on January 1, 2007, at 10:15:28
>Would a bad attitude keep morphine from working? >No way. That's the difference between a drug >that really works and one that doesn't.
Antidepressants are like interperative art. If you try really really hard, you can see the picture you want to see. But there is no mistake about it when somebody sees a photograph.There have been good antidepressants.
Hundreds of componds have probably come and gone by the wayside, thrown in the trash because they just happen to be universal mood brigheners.
A side effect of healing the sick just might happen to be making a normal person feel better.
Now why on earth was amineptine taken off the market? It was a very effective antidepressant but it had a small abuse potential.
So let me get this straight. We can drug kids up with addictive ADHD drugs, but when an effective antidepressant comes along with a small potential for abuse it gets taken off the market?
Why are ADHD drugs allowed to posess potential for addiction but antidepressants must not?
Linkadge
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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