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Medical Forum / General / Pharmacy / May 2004Antidepressants- 75 percent duplicated by placebo
"Dr. Zarkov" <Ming@Mongo.com> wrote in message news:<408e905f$0$28928$61fed72c@news.rcn.com>... > "SzaszFan" <enalg@yahoo.com> wrote in message > news:BCB3533F.B491%enalg@yahoo.com... > > bf456302.0404261449.75affd2c@posting.google.com, "Barbara Schwarz" > > <StilllovingMarty@myway.com> wrote: > > > > > newzforyou@aol.com (NewzForYou) wrote in message > > >> Although antidepressant medication is widely regarded as efficacious, a > > >> recent > > >> meta-analysis of published clinical trials indicates that 75 percent of > the > > >> response to antidepressants is duplicated by placebo (Kirsch & > Sapirstein, > > >> 1998). These data have been challenged on a number of grounds, > including the > > >> restriction of the analyses to patients who had completed the trials, > the > > >> limited number of clinical trials assessed, the methodological > > >> characteristics > > >> of those trials, and the use of meta-analytic statistical procedures > (Klein, > > >> 1998). > > >> > > >> http://www.journals.apa.org/prevention/volume5/pre0050023a.html > > > > > > Which confirms agains that psychiatry is a junk science and the pharma > > > industry a scam business. > > > > Well, placebo effects *do* mean actual meaningful, therapeutic change, > > just to put things in perspective. However, it is certainly true (and its > my > > belief as well) that probably all antidepressant meds operate on the > placebo > > effect. There's also the "active placebo" effect to take into account as > > well, which traditional double-blind placebo-controlled ("sugar pill") > > methodology fails to take into account. > > > > It goes like this- you have two groups of depressives. One gets Prozac, > > the other gets sugar pills. Neither the staff/investigators nor the > > participants know who's getting the active drug... Right? Well, problem is > > the initial effect of Prozac is typically a stimulative effect, > > light-headedness, perhaps a very slight "high," which unblinds the trial. > >... > > Those effects of antidepressants by which they can generally be > distinguished from placebo do not invalidate the trials. If it were a > purely placebo effect, why would it be delayed several weeks? What is delayed? > And why would > antidepressants work in animal models? Well, doc, I tell you why. Because animal can't talk. The doctors just make up that "wof, wof, miau, pieps and oink oink" means "Oh, I feel so well, the anti-depressive made me so happy!" What those animals really say is: "Leave me alone with that poison, doc, and swallow the dangerous garbage yourself!" Barbara Schwarz "Barbara Schwarz" <StilllovingMarty@myway.com> wrote... > "Dr. Zarkov" <Ming@Mongo.com> wrote in message news:<408e905f$0$28928$61fed72c@news.rcn.com>... > > "SzaszFan" <enalg@yahoo.com> wrote ... > > > bf456302.0404261449.75affd2c@posting.google.com, "Barbara Schwarz" wrote: > > > > newzforyou@aol.com (NewzForYou) wrote in message > > > >> Although antidepressant medication is widely regarded as efficacious, a [quoted text clipped - 14 lines] > > > >> > > > >> http://www.journals.apa.org/prevention/volume5/pre0050023a.html ...> > > > > > Well, placebo effects *do* mean actual meaningful, therapeutic change, > > > just to put things in perspective. However, it is certainly true (and its [quoted text clipped - 27 lines] > What those animals really say is: "Leave me alone with that poison, > doc, and swallow the dangerous garbage yourself!" The relief from depression is delayed by several weeks after starting the antidepressant. And why would one antidepressant often not work while a second does if it's purely a placebo effect? You can see actual behavioral changes in the animal models similar to those expected in humans. As I mentioned above, Prozac has been used in veterinary practice (though not for depression AFAIK). See, for example: Monleon S, et al. Attenuation of sucrose consumption in mice by chronic mild stress and its restoration by imipramine. Psychopharmacology. 1994;117:453-457. Willner P. Animal models of depression. In: Willner P (ed) Behavioral Models in Psychopharmacology. University Press, Cambridge, 1991. Willner P. Animal models of depression: validity and applications. In: Gessa G, Fratta W, Pani L, Serra G (eds) Depression and Mania: From Neurobiology to Treatment. New York: Raven Press, 1995. Kelly JP, Wrynn AS, Leonard BE. The olfactory bulbectomized rat as a model of depression: an update. Pharmacol Ther 1997;74(3):299-316. > "Barbara Schwarz" <StilllovingMarty@myway.com> wrote... > > "Dr. Zarkov" <Ming@Mongo.com> wrote in message [quoted text clipped - 66 lines] > antidepressant. And why would one antidepressant often not work while a > second does if it's purely a placebo effect? When do you doctors finally get that an animal and a human is something different? What makes animals happy does not make humans automatically happy. If you give a cat a dead rat she might be happy, but try that with your wife. Let me know what she said. :) Anyway, who says that those animals trials were not doctored? Who says that those results are not doctored for the favor of the pharma industry? Barbara Schwarz On 29-04-2004 00:17, in article bf456302.0404281417.51e7e869@posting.google.com, "Barbara Schwarz" <StilllovingMarty@myway.com> wrote: > Anyway, who says that those animals trials were not doctored? Who says > that those results are not doctored for the favor of the pharma > industry? > > Barbara Schwarz Yep Barbara, it is a conspiracy to enslave or kill everyone. That is the way to profit, you know. Vote out Bush. EJ On 4/28/04 12:06 AM, in article 408f2df4$0$28906$61fed72c@news.rcn.com, "Dr. Zarkov" <Ming@Mongo.com> wrote: <snip> > The relief from depression is delayed by several weeks after starting the > antidepressant. I can tell you from personal experience that patients in clinical drug trials are frequently very saavy about the purported nature of psychiatric drug effects, and know that if they are getting an active drug, they will likely not feel the full effects in a few weeks. The power of suggestion is a powerful thing... I don't find it hard to believe that a patient in an unblinded clinical trial can experience placebo-induced remission of symptoms that builds over several weeks. > And why would one antidepressant often not work while a > second does if it's purely a placebo effect? Different drugs feel different to patients. Who knows, the active effects of an SSRI might "feel more therapeutic" to a patient than the active effects of a TCA. More to the point, it seems like in some ways you're asking me to prove a negative in both cases. The *point* of placebo-controlled trials is to make sure there is no chance of any demand characteristics or the power of suggestion to contaminate the effects of a clinical trial. Since active-placebo effects unblind clinical trials, I don't have to account for every possible ways placebo effects might work. Instead, the FDA and clinical researchers need to get off their collective a.ses and realize this is an issue which needs to be tackled, lest someday people find out that the psychiatric emperor is wearing no clothes. <snip >"Barbara Schwarz" <StilllovingMarty@myway.com> wrote... >> "Dr. Zarkov" <Ming@Mongo.com> wrote in message [quoted text clipped - 66 lines] >antidepressant. And why would one antidepressant often not work while a >second does if it's purely a placebo effect? In his studies of anti-depressants, Dr. Healy found that suicidal ideation and akathisia are likely to hit in the first week of taking the drug. So noticeable effects are not delayed by several weeks. snip snip... The latest info indicates that placebo effects are not only mental phenomena; giving NS (normal saline) as a placebo for MS (morphine sulphate) causes a bodily response that can be halted by the administration of IV Narcan (naloxone) which competetively binds with the receptor sites for MS, reversing analgesia. So the placebo effect of SSRI's, MAOI's, and other antidepressants is not to be discounted. gm stanbery >snip snip... >The latest info indicates that placebo effects are not only mental [quoted text clipped - 4 lines] >of SSRI's, MAOI's, and other antidepressants is not to be discounted. >gm stanbery One could question why drugs like SSRI, with such a long list of dangerous side-effects, should be used at all when they are no more effective than a placebo. My guess would be it's the "profit desire syndrome" that the pharmaceutical companies and psychiatrists are suffering from. >snip snip... >The latest info indicates that placebo effects are not only mental [quoted text clipped - 4 lines] >of SSRI's, MAOI's, and other antidepressants is not to be discounted. >gm stanbery Exactly, which is why double-blind testing against placebos are so important. If the drug being tested does better than the placebo and the patients cannot tell which they are being given, then the drug has a "real" effect beyond the placebo effect. Most people have a mistaken belief that the "placebo effect" is somehow either illusory or "all in the mind". It isn't. It is a very real effect, and explains why some people respond to *any* form of treatment. And the placebo effect has been known for a long time. For example, studies over thirty years ago showed that wart cures worked better when people believed in the cure, no matter what the cure actually was. The effect was real -- the warts would go away. -Pete Zakel (phz@seeheader.nospam) There was a young poet named Dan, Whose poetry never would scan. When told this was so, He said, "Yes, I know. It's because I try to put every possible syllable into that last line that I can." Here is something new for you guys to think about. Two million kids in the USA have sleep order. And not just bad dreams. There are kids that suffer from "sleep terror". Their parents say that their kids gets up in the middle of the night and are other persons. They speak and act as they would be somebody else. And in the morning the kid would not remember that spectacle at all. What happen here is again that psychiatrists, mindcontrollers (SEGNPMSS) talks in the subconcious mind of those kids (also adult) and make them do those things. They do that via ear implants and body implants of the victims. Sleep walking, night eating, alien hand syndrome, multible personality disorder, and more are the clear evidence that somebody is taking over the mind and body of a person. Instead of pumping those poor victims full with drugs, it should be rather investigated if there is not a medical terror group that helps the pharma industry to sell poison by invading people's lives with such inhuman techniques. Barbara Schwarz On 07-05-2004 00:44, in article bf456302.0405061444.230da5fb@posting.google.com, "Barbara Schwarz" <StilllovingMarty@myway.com> wrote: > Here is something new for you guys to think about. > > Two million kids in the USA have sleep order. Sleep order? Vote out Bush. EJ In sci.med.pharmacy Barbara Schwarz <StilllovingMarty@myway.com> wrote: > What happen here is again that psychiatrists, mindcontrollers > (SEGNPMSS) talks in the subconcious mind of those kids (also adult) > and make them do those things. They do that via ear implants and body > implants of the victims. Please go away... >>snip snip... >>The latest info indicates that placebo effects are not only mental [quoted text clipped - 21 lines] >-Pete Zakel > (phz@seeheader.nospam) The original point that was made was that the doctors know which group are on the drugs versus the placebo and can therefore influence the results. How can that be prevented so the clinical trial results are truthful? >>> snip snip... >>> The latest info indicates that placebo effects are not only mental [quoted text clipped - 35 lines] > > How can that be prevented so the clinical trial results are truthful? You don't know what double-blind testing is, do you?  SignatureRon of that ilk. > >>> snip snip... > >>> The latest info indicates that placebo effects are not only mental [quoted text clipped - 33 lines] > > are on the drugs versus the placebo and can therefore influence the > > results. No, the original point was that patients recognized the presence or absence of the CNS side effects and as such could correctly "guess" whether they are on treatment or placebo. This raised the suggestion that "active placebos" are a good solution. Note that in testing SSRIs in depression, the primary endpoint is patient self report symptoms uswing, typically, either the Hamilton Depression Scale or Zungs deptression scale. As these are self-reports, the influence of the physician on the results is not a factor on efficacy. > > How can that be prevented so the clinical trial results are truthful? > You don't know what double-blind testing is, do you? The question is one of maintaining the integrity of the blind first, and the effect that some guessing might have on results second. The answer remains - the incremental benefit of active over placebo is statistically significant and clinically meaningful. Moreover, particularly when evaluating completers and/or responders, it is evident that the treatments can and do improve patient otcomes. Considering that the effect on the "average" patient is significant and that not all drugs work in all people (for a variety of reasons), an adequate trial on antidepressants is rational and medically appropriate therapy in patients meeting the criteria of a depression diagnosis. js >> > The original point that was made was that the doctors know which group >> > are on the drugs versus the placebo and can therefore influence the [quoted text clipped - 9 lines] >self-reports, the influence of the physician on the results is not a >factor on efficacy. There is always a problem measuring depression... it consists as much of psyhcomotor symptoms as mood changes. I would be happier taking a video and trying to "numericise" it for amount and speed of body movement, amount and word-rate of speech, loudness and clarity of speech compared to other sessions with the same patient, amount of eye contact, etc, (in the most part looking for changes relative to earlier sessions of the same patient). You could try timing them on a series of similar puzzles from session to session. If possible it would be nice to have people on a food-and-lodging basis when not in tests -- the whole point being they could take as much or little of the food stock for themselves at times of their own choosing -- and try to get sleep and appetite values from video footage. Signature"If I have seen further than other men, (0_ it is because I have been surrounded (o. | (o. (o. by pygmies." /\ //\ /\ /\ \/_ V_/_ \/_ \/_ <snip> >> > The original point that was made was that the doctors know which group >> > are on the drugs versus the placebo and can therefore influence the [quoted text clipped - 4 lines] >whether they are on treatment or placebo. This raised the suggestion >that "active placebos" are a good solution. Thanks, you put that better than I did. The definitions of "active placebo" I found are: "a placebo used in experimental tests of a drug that has noticeable side effects; 'an active placebo mimics the side effects of the experimental drug'". http://lookwayup.com/lwu.exe//lwu/d?t=&h=&s=f&b=&w=active_placebo&pos=n&Syn_ID=2 276939&st=relX "active placebo, impure placebo: a substance having pharmacologic properties that are not relevant to the condition being treated." http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszS zcommonzSzdorlandszSzdorlandzSzdmd_p_22zPzhtm#1077729 If an active placebo mimics the side effects of the experimental drug, then how do we know for sure that the active placebo itself is truly a placebo and not an active drug in its own right? > <snip> > [quoted text clipped - 25 lines] > then how do we know for sure that the active placebo itself is truly a > placebo and not an active drug in its own right? Good point! Interpersonal therapy (IPT) was originally tested as a placebo therapy and found to be more effective than the the therapies it was being tested against. Maybe it's the side effects that explain how some drugs work, in as much as they work better than placebo. A loss of mental sharpness, for example, might help someone feel less depressed. >>>> snip snip... >>>> The latest info indicates that placebo effects are not only mental [quoted text clipped - 37 lines] > >You don't know what double-blind testing is, do you? You haven't been reading the thread or you'd know what we have and haven't been talking about. I'd suggest you do some homework before blundering in and displaying your ignorance. On 5/5/04 5:28 PM, in article 40a00728.1737538@news.newsguy.com, "Mr. Nobody" <noone@nowhere.com> wrote: > In his studies of anti-depressants, Dr. Healy found that suicidal > ideation and akathisia are likely to hit in the first week of taking > the drug. So noticeable effects are not delayed by several weeks. Which means that people should be closely monitored during the first part of any new medicinal regime. Vote out Bush. EJ On 28-04-2004 00:37, in article bf456302.0404271437.36217848@posting.google.com, "Barbara Schwarz" <StilllovingMarty@myway.com> wrote: >> Those effects of antidepressants by which they can generally be >> distinguished from placebo do not invalidate the trials. If it were a >> purely placebo effect, why would it be delayed several weeks? > > What is delayed? Onset of effects and movement toward lower levels of depression Vote out Bush. EJ |
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