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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Phillipa on December 27, 2011, at 20:33:12
Title cut down. After posting above thread this comes in my mail today. Interesting. Phillipa
From Reuters Health Information
Antidepressant, Talk Therapy Fail to Beat PlaceboNEW YORK (Reuters Health) Dec 22 - Neither antidepressants nor "talk therapy" were able to outperform placebo pills in a new clinical trial on depression treatment -- although there were hints that the effects varied by gender and race, researchers report.
The findings, published November 29 in the Journal of Clinical Psychiatry, add to evidence that people receiving "real" depression treatment in studies -- from antidepressants to St. John's wort -- often do no better than people given a placebo.
A recent review found that a minority of antidepressant users even fared worse than placebo users.
In this latest study, researchers randomly assigned 156 patients with major depression to either take sertraline daily for 16 weeks; take a placebo for the same period, or undergo supportive-expressive therapy twice a week for four weeks and then weekly for 12 weeks.
The three groups did similarly overall.
In the antidepressant group, 31% responded (as judged by improvements on the Hamilton Rating Scale for Depression). The same was true of about 28% of patients in the talk-therapy group, and 24% in the placebo group.
"I was surprised by the results. They weren't what I'd expected," said lead researcher Dr. Jacques P. Barber, dean of the Institute of Advanced Psychological Studies at Adelphi University in Garden City, New York.
Still, he stressed in an interview, the lack of benefit over placebo does not mean that depression therapies are pointless.
For one, Dr. Barber said, receiving a placebo in a clinical trial "is not the same as getting no treatment."
Study participants in placebo groups have contact with health professionals who are asking about their symptoms and well-being, he said. And for some people, that attention can make a difference -- and may help explain the placebo response seen in studies.
In addition, at least some people in placebo groups believe they are getting the real treatment - and people's beliefs about their therapy can play a key role in whether they get better.
But apart from that, different people may respond differently to a given type of depression therapy. Dr. Barber's team found some evidence of that.
The study had an unusually large minority population for a clinical trial on depression: Forty-five percent of the patients were African American.
The researchers found that African-American men tended to improve more quickly with talk therapy than with medication or placebo. In contrast, white men fared best on placebo, while black women showed no differences in their responses to the three treatments.
Only white women, Dr. Barber said, showed the expected pattern: a quicker response to both medication and talk therapy than to the placebo.
But all of that is based on fairly small numbers of people, and more research is needed to see if the gender and racial differences are real, according to Dr. Barber.
A psychiatrist not involved in the study agreed. "Those findings are interesting, but need to be interpreted with a grain of salt," said Dr. David Mischoulon from Harvard Medical School.
As for the overall lack of benefit from the real treatments over placebo -- in this and other studies - Dr. Mischoulon cautioned against reading that as "nothing works for depression."
"I think it's the opposite," he told Reuters Health, "It's more that, everything seems to work to some degree."
Like Dr. Barber, Dr. Mischoulon said that the placebo condition in clinical trials is not really "no treatment."
Instead, he said, "I try to offer as broad a menu of options as possible, because all may potentially help." Dr. Mischoulon has also studied alternative depression remedies, like fish oil and acupuncture.
Another caveat from the current study, he noted, is that it looked only at two types of medication. (Some patients were switched to venlafaxine if they did not respond to sertraline after eight weeks). And it tested just one type of talk therapy.
Supportive-expressive therapy is a short-term form of psychoanalysis that aims to help people understand how their personal relationships are related to their symptoms.
It's different from cognitive behavioral therapy, the best-studied form of talk therapy for depression. Both Dr. Barber and Dr. Mischoulon said it's not clear if the current findings would extend to psychotherapies other than supportive-expressive therapy.
"This is one type of psychotherapy, and it's two antidepressants," Dr. Mischoulon said. "It would be wrong to conclude that psychotherapy doesn't work, and antidepressants don't work."
The study was funded by the National Institutes of Health. Some of Dr. Barber's co-researchers have received funding from the pharmaceutical industry.
SOURCE: http://bit.ly/vjbLCM
J Clin Psychiatry 2011.
Posted by SLS on December 27, 2011, at 21:24:32
In reply to Antidepressants, Talk Theraphy, Placebos All Same, posted by Phillipa on December 27, 2011, at 20:33:12
I am not surprised by this.
Investigators seem to be less and less selective of whom they include in depression studies. I don't think they properly exclude cases that are not MDD. Selecting cases of greater severity using accepted depression scales would help correct for this. Scores of greater than 25 on the HAM-D would work.
- Scott
Posted by Dinah on December 28, 2011, at 9:19:01
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same, posted by SLS on December 27, 2011, at 21:24:32
I think I'm going to find all studies that make no attempt to differentiate between various forms of depression as fundamentally flawed.
There's a difference between depression secondary to relationship problems, or life problems, and depression secondary to anxiety, and melancholic depression that appears without life stressors.
It's like doing a study with a triptan and finding it was no more effective than placebo for a good number of headache sufferers. Of course it isn't. If it's not a migraine, a triptan won't work at all. If it's a caffeine withdrawal headache it would likely respond best to medications with caffeine. If it's a tension headache it would respond best to something else.
We're nowhere near as advanced as headache studies.
If what this does is tell primary care doctors that handing a pill to someone complaining of symptoms of depression, I'm all for it. It could well be that they need help in changing or coping with life stressors. If it tells psychiatrists to look into things more closely before handing out a Prozac, that's great.
If what they're doing is saying that in general antidepressants are no better than placebos, I think they're doing us a disservice. And I'm saying that as someone who found antidepressants worse than placebos. They weren't the right medication for *me*.
Posted by SLS on December 28, 2011, at 10:30:22
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same, posted by Dinah on December 28, 2011, at 9:19:01
I love it when you get feisty.
- Scott
Posted by gadchik on December 28, 2011, at 12:10:39
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same, posted by Dinah on December 28, 2011, at 9:19:01
Reading what you have to say really enlightens me.I think you explained it brilliantly!
Posted by bleauberry on December 28, 2011, at 15:41:19
In reply to Antidepressants, Talk Theraphy, Placebos All Same, posted by Phillipa on December 27, 2011, at 20:33:12
Here is how I view this type of scenario.
First of all I do not accept the premise that meaningful results are obtained by viewing "depression" as something that is the same from person to person. The symptoms are the same, for sure, but not the underlying cause or malfunction.
Therefore there are different kinds of depression....such as pathogenic or biological, life circumstances, genetical, environmental insults either physical or mental, and unexplained. Each of these is going to respond to a different method specific to the cause. Since the body and brain or so complicated beyond our wisdom we might never know for sure what the cause is in any particular person, which means it is a random roll of the dice with various treatments to see what sticks and what doesn't.
That's what happens in all these studies. And that's why the percentages of responders in each treatment group wasn't much different. The percentage of people that needed an antidepressant was about the same as the percentage of people who needed counseling and about the same as people who found a biological problem and about the same as any other group. The placebo people.....who knows, they had the unexplained depression and for whatever reason it was temporary....the whole ordeal of the clinical setting and such was enough to snap out of it. Or they had a life issue that they came to terms with sometime during the trial and their outlook improved.
That's the way I explain these apparently confusing deceiving numbers coming out of trials. They are flawed before they even begin by using a flawed view of what depression is.
While depression is a disease in its own right, it is also a symptom, and that's where I think they get it wrong. They see it as only a disease.
Posted by SLS on December 28, 2011, at 16:03:43
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same, posted by bleauberry on December 28, 2011, at 15:41:19
Exactly.
- Scott
> Here is how I view this type of scenario.
>
> First of all I do not accept the premise that meaningful results are obtained by viewing "depression" as something that is the same from person to person. The symptoms are the same, for sure, but not the underlying cause or malfunction.
>
> Therefore there are different kinds of depression....such as pathogenic or biological, life circumstances, genetical, environmental insults either physical or mental, and unexplained. Each of these is going to respond to a different method specific to the cause. Since the body and brain or so complicated beyond our wisdom we might never know for sure what the cause is in any particular person, which means it is a random roll of the dice with various treatments to see what sticks and what doesn't.
>
> That's what happens in all these studies. And that's why the percentages of responders in each treatment group wasn't much different. The percentage of people that needed an antidepressant was about the same as the percentage of people who needed counseling and about the same as people who found a biological problem and about the same as any other group. The placebo people.....who knows, they had the unexplained depression and for whatever reason it was temporary....the whole ordeal of the clinical setting and such was enough to snap out of it. Or they had a life issue that they came to terms with sometime during the trial and their outlook improved.
>
> That's the way I explain these apparently confusing deceiving numbers coming out of trials. They are flawed before they even begin by using a flawed view of what depression is.
>
> While depression is a disease in its own right, it is also a symptom, and that's where I think they get it wrong. They see it as only a disease.
>
>
Posted by jhj on December 28, 2011, at 23:59:35
In reply to Antidepressants, Talk Theraphy, Placebos All Same, posted by Phillipa on December 27, 2011, at 20:33:12
I have tried almost all available meds, spent years in CBT and also tried ECT for my dysthymia over last nine years. Based on my experience i agree with the findings in a way that neither of these treatment works or is any better than placebo.
Posted by SLS on December 29, 2011, at 5:34:28
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same, posted by jhj on December 28, 2011, at 23:59:35
>
> I have tried almost all available meds, spent years in CBT and also tried ECT for my dysthymia over last nine years. Based on my experience i agree with the findings in a way that neither of these treatment works or is any better than placebo.Dysthymia is a bitch to treat, and is not considered to be MDD. You should probably be excluded from a MDD study based upon that. It is not surprising that your dysthymia has not been adequately treated by MDD therapies.
I sincerely hope that you find something that puts a dent in your mood illness. Do stimulants help at all? What about a drug like Mirapex? Amisulpride is worth a try. Google amisulpride and dysthymia.
Good luck.
- Scott
Posted by Dinah on December 29, 2011, at 21:23:14
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same » Dinah, posted by SLS on December 28, 2011, at 10:30:22
It's not so much that I want to defend psych meds.
It's more that I want to encourage good science.
Scientists need to be scrupulous in reporting. Credibility is part of their stock in trade.
Posted by Tony P on January 3, 2012, at 22:13:15
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same » jhj, posted by SLS on December 29, 2011, at 5:34:28
The results don't surprise me given the many weaknesses in the design. As I think someone else commented, the results could also be interpreted as "ANY _single_ treatment works for about 1/3 of depressed patients", which agrees with most other studies I have seen.
My biggest beef with small but over-generalized studies like this is that they take no account of individual responses to ADs, far worse in this case because only 2 ADs were considered.
As an example, survey papers comparing SNRIs generally conclude that Cymbalta is inferior to Effexor overall (as a result, my drug plan covers Effexor but not Cymbalta. Grrr.). However, for me Effexor is intolerable because of side-effects, Cymbalta is more effective than nearly every AD I have tried, and has almost zero S/E. My pdoc has also found Cymbalta effective & low S/E with many of his patients. Where am I in these collective averages?
Posted by SLS on January 4, 2012, at 1:50:18
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same, posted by Tony P on January 3, 2012, at 22:13:15
> The results don't surprise me given the many weaknesses in the design. As I think someone else commented, the results could also be interpreted as "ANY _single_ treatment works for about 1/3 of depressed patients", which agrees with most other studies I have seen.
>
> My biggest beef with small but over-generalized studies like this is that they take no account of individual responses to ADs, far worse in this case because only 2 ADs were considered.
>
> As an example, survey papers comparing SNRIs generally conclude that Cymbalta is inferior to Effexor overall (as a result, my drug plan covers Effexor but not Cymbalta. Grrr.). However, for me Effexor is intolerable because of side-effects, Cymbalta is more effective than nearly every AD I have tried, and has almost zero S/E. My pdoc has also found Cymbalta effective & low S/E with many of his patients. Where am I in these collective averages?
Very valid points.
- Scott
Posted by Dinah on January 4, 2012, at 9:22:12
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same, posted by Tony P on January 3, 2012, at 22:13:15
That makes me angry. They should have to live with the side effects of certain medications themselves before thrusting it at others. Effexor was awful for me, and made me miserably agitated (as did Wellbutrin). I couldn't bear it. Luvox was tolerable.
Are there any other pure SSRI's offered by your plan? Effexor also acts on NE, doesn't it?
Posted by Franz on January 4, 2012, at 13:47:56
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same, posted by Tony P on January 3, 2012, at 22:13:15
> As an example, survey papers comparing SNRIs generally conclude that Cymbalta is inferior to Effexor overall (as a result, my drug plan covers Effexor but not Cymbalta. Grrr.). However, for me Effexor is intolerable because of side-effects, Cymbalta is more effective than nearly every AD I have tried, and has almost zero S/E. My pdoc has also found Cymbalta effective & low S/E with many of his patients. Where am I in these collective averages?
>Good to know. I also read those papers about new SNRIs not better than fluoxetine and escitalopram. Both caused me side effects,lethargy, tinnitus.
I thought the only alternative was tianeptine.
Regarding "talk therapy" I believe sometimes it can be useless or bad depending on the therapist e.g. a silent psychoanalyst or overthinking on your problems. Sometimes I think the best effect is from getting out to go to the Dr office.
Placebo and suggestion plays a great part in therapy and if you are too rational or distant from people you are less likely to benefit.
Posted by Phillipa on January 4, 2012, at 19:39:48
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same » Tony P, posted by Dinah on January 4, 2012, at 9:22:12
Dinah you took luvox? Did it work for you? How long how high a dose. Phillipa
Posted by Dinah on January 5, 2012, at 1:13:10
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same » Dinah, posted by Phillipa on January 4, 2012, at 19:39:48
I took it for four years, I think. The dose eventually got to the maximum, and the pdoc from h*ll wanted to raise it even more.
I guess it depends on what you mean by "work". It did help with the obsessions, and a bit with the frazzled feeling. But it caused some other problems, and overall I wish I'd never been on it.
But that's me, with my brain chemistry. I'm far better off with AP's, I think.
Posted by Phillipa on January 5, 2012, at 18:52:03
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same » Phillipa, posted by Dinah on January 5, 2012, at 1:13:10
Dinah what type of problems? Big decisions coming up? Jan/P
Posted by Dinah on January 7, 2012, at 14:13:25
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same » Dinah, posted by Phillipa on January 5, 2012, at 18:52:03
I don't know if all Luvox users would have the same problems. I'm Bipolar 3, possibly, or at least bipolarish. Luvox was calming on an outer level, but was agitating on a lower level. It also may have weakened inhibitions. I self injured for the first time on Luvox, and did it fairly frequently. Since going off Luvox, it's happened so rarely as to be a non-issue.
But I think that's likely not a problem for people who don't have bipolar tendencies. If you don't, you should be fine. And if it works, why stop it? You say you felt better on 250 mg than you did at any other time? I think I maxed out at 300 mg, and my doctor wanted to put me on a higher dose. Why not take the 250 mg if it helps you? Why stop it if it works for you?
Posted by Phillipa on January 7, 2012, at 21:12:22
In reply to Re: Antidepressants, Talk Theraphy, Placebos All Same » Phillipa, posted by Dinah on January 7, 2012, at 14:13:25
Dinah strange the second time a doc raised the dose years ago to 200mg I also experience something similar which I questioned the doc about. I for the first time in my life was waking up early like six which is unheard of in me all of life and felt great was making baskets and selling at flea markets. It lasted about two weeks and then quit doing that? I wonder now what it was? The doc said I just didn't know what it felt like to feel good. Not true as felt great when working and still slept late hence 3-11 shift. Thanks Jan/P
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