Interesting article on efficacy of AD drugs
in [Medication]
|
Prev: Study finds a whopping 1 in 20 Americans want take the law into their own hands wrt shutting Linda's pie hole
Next: Effexor V Prozac combined with Wellbutrin
From: hal on 9 Jun 2008 20:23 Interesting study on treatments of depression with and without AD drugs. Bottom line: the stuff doesn't work any better than placebo. Hal http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2234409 BMC Med. 2007; 5: 36. Published online 2007 December 7. doi: 10.1186/1741-7015-5-36. PMCID: PMC2234409 Copyright � 2007 Hermens et al; licensee BioMed Central Ltd. Clinical effectiveness of usual care with or without antidepressant medication for primary care patients with minor or mild-major depression: a randomized equivalence trial Conclusion UCandAD was as effective as UCnoAD over the first 6 weeks, but not at 13, 26, and 52 weeks. However, superiority of either treatment could not be demonstrated either. The question whether antidepressants add any clinical effect to usual care remains unresolved. We recommend future studies to look for subgroups of patients who may benefit from antidepressants.
From: Larry Hoover on 9 Jun 2008 21:06 <hal(a)nospam.org> wrote in message news:f4ir441e224pifbu2akcc07fsa2dtlbp6t(a)4ax.com... > Interesting study on treatments of depression with and without AD > drugs. > > Bottom line: the stuff doesn't work any better than placebo. > > Hal > > > http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2234409 That's not what the study showed, Hal. First off, the subjects had been diagnosed only with minor or mild-major depression, a subject group notoriously unresponsive to antidepressant medication, generally accepted to be due to the high rate of spontaneous remission. In many countries, standard practise is merely to monitor such individuals, and to medicate only if symptoms worsen, or persist for an extended period. All prior research in this subject group has been equivocal, so it's pretty reasonable to expect that here, too. In any case, the findings were *not* that antidepressants did not work better than placebo. Look at figure 2: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2234409&rendertype=figure&id=F2 What you see is that every set of observations favoured antidepressant treatment, and that the trend became stronger as the observation period progressed. The per-protocol observations (blue bars) obtained statistically significant superiority at 26 and 52 weeks. Only when subjects who violated the protocols were included in the statistical analyses do we lose significance, i.e. those who broke the trial guidelines dilute the observations of those who adhered to them. IMHO, the per protocol findings are the ones with validity, unless one seeks to dismiss the use of antidepressants. The intention-to-treat analysis might yet have obtained significance if there were more subjects under study, increasing the power. In the context of what we know from other work, there is nothing new here, other than the biased reporting. Lar
From: Larry Hoover on 9 Jun 2008 21:53 <hal(a)nospam.org> wrote in message news:f4ir441e224pifbu2akcc07fsa2dtlbp6t(a)4ax.com... > Interesting study on treatments of depression with and without AD > drugs. > > Bottom line: the stuff doesn't work any better than placebo. P.S. The study did not use placebo. Lar
From: hal on 9 Jun 2008 22:00 On Mon, 9 Jun 2008 21:06:41 -0400, "Larry Hoover" <larryhoover(a)nexicom.net> wrote: > ><hal(a)nospam.org> wrote in message >news:f4ir441e224pifbu2akcc07fsa2dtlbp6t(a)4ax.com... >> Interesting study on treatments of depression with and without AD >> drugs. >> >> Bottom line: the stuff doesn't work any better than placebo. >> >> Hal >> >> >> http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2234409 > >That's not what the study showed, Hal. > >First off, the subjects had been diagnosed only with minor or mild-major >depression, a subject group notoriously unresponsive to antidepressant >medication, generally accepted to be due to the high rate of spontaneous >remission. In many countries, standard practise is merely to monitor such >individuals, and to medicate only if symptoms worsen, or persist for an >extended period. All prior research in this subject group has been >equivocal, so it's pretty reasonable to expect that here, too. In any case, >the findings were *not* that antidepressants did not work better than >placebo. Look at figure 2: >http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2234409&rendertype=figure&id=F2 > >What you see is that every set of observations favoured antidepressant >treatment, and that the trend became stronger as the observation period >progressed. The per-protocol observations (blue bars) obtained statistically >significant superiority at 26 and 52 weeks. Only when subjects who violated >the protocols were included in the statistical analyses do we lose >significance, i.e. those who broke the trial guidelines dilute the >observations of those who adhered to them. IMHO, the per protocol findings >are the ones with validity, unless one seeks to dismiss the use of >antidepressants. The intention-to-treat analysis might yet have obtained >significance if there were more subjects under study, increasing the power. > >In the context of what we know from other work, there is nothing new here, >other than the biased reporting. > >Lar I don't know, this sounds pretty clear: Conclusion Usual care combined with paroxetine (UCandAD) was as effective as (equivalent to) usual care alone (UCnoAD) over the first 6 weeks, but not thereafter. We found small differences in effectiveness in favor of UCandAD, but superiority was not demonstrated. We cannot but conclude that the question 'Do antidepressants add any effectiveness to usual care?' remains open. We recommend future studies to distinguish between subgroups of patients who might benefit from antidepressant medication. Until then, the potential benefits of adding an antidepressant to usual care alone must be balanced judiciously against possible harms such as side effects and dependence. Moreover, patients should be properly informed about the advantages and disadvantages of interventions in order to enable them to make a balanced choice.
From: hal on 9 Jun 2008 22:20
On Mon, 9 Jun 2008 21:53:33 -0400, "Larry Hoover" <larryhoover(a)nexicom.net> wrote: > ><hal(a)nospam.org> wrote in message >news:f4ir441e224pifbu2akcc07fsa2dtlbp6t(a)4ax.com... >> Interesting study on treatments of depression with and without AD >> drugs. >> >> Bottom line: the stuff doesn't work any better than placebo. > >P.S. The study did not use placebo. yes, that is correct. This particular study compared standard treatments with and without the use of AD drugs. There are numerous other studies that used placebos and they indicated there was no statistically significant difference between placebo and AD drugs except possibly in the case of severely depressed patients and even in that case the differences was not great. I would be happy to post the links if you are interested. Hal > >Lar > |