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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on September 9, 2007, at 13:43:45
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:54:25
I am just playing the devil's advocate here as I often do. There is plenty of literature on the topic of how antidepressants fair in comparison to placebos.
There have been plenty of studies which try to determine the overal effect of the placebo by analyzing previous clinical trials and studies.
You can get an idea of the gravity of the placebo effect by typing in antidepressant + placebo into your favorite search engine.
I am not going to argue that antidepressants don't work, because that is impossble, but I can argue that placebos work as well as antidepressants in most clinical trials becuase that is fact based.
Linkadge
Posted by linkadge on September 9, 2007, at 13:46:38
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:54:25
The black box warning was placed on antidepressant use in kids for two reasons.
1) The possability of increased suicidialty.
2) The general lack of data supporting the
efficacy of antidepressants in children.Trends of suicide go up and down, one cannot form an oppinion so close to the time after the warning was issued.
http://www.mcmanweb.com/FDA_suicide.htm
Linkadge
Posted by linkadge on September 9, 2007, at 13:48:22
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:54:25
http://www.mcmanweb.com/FDA_suicide.htm
>The FDA acted on the strength of a report by its >lead investigator into the drug trials, Andrew >Mosholder MD. The report suggested evidence of >an increased suicide risk in kids based on a >review of 25 pediatric trials, 16 related to >depression. The report also found that only >three in 15 pediatric depression trials had >succeeded, thus putting the issue of benefits vs >risk on the table.
Linkadge
Posted by Larry Hoover on September 9, 2007, at 14:12:13
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
> Web address: http://www.sciencedaily.com/releases/2007/09/070907095628.htm
>
> related story:
> http://www.nytimes.com/2007/09/07/health/07suicide.html?_r=1&oref=slogin
>
> Newer Antidepressants Led To Less, Not More, Teen SuicidesHere's the full-text of the original research:
http://health.usf.edu/nocms/publicaffairs/now/gibbons_ajp_200709.pdfI think the figures are compelling.
Lar
Posted by Phillipa on September 9, 2007, at 17:29:37
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:52:27
Knowledge is power learning leads to new knowledge. That's why and asking questions is how you learn. Phillipa ps every post yields new knowledge to me. Maybe one day that moment of Ahhh that's me exactly will happen as posts seem sometimes to veer off the topic never know where they will lead.
Posted by Phillipa on September 9, 2007, at 17:32:27
In reply to Please be sensitive » Phillipa, posted by Deputy 10derheart on September 9, 2007, at 11:12:35
l0der I also take ad's just trying to learn more. Reworded to mean why are adults taking less antidepressants. Sorry about this. Phillipa
Posted by Phillipa on September 9, 2007, at 17:40:34
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
Reread your thread and looks like you want to concentrate on teens. So sorry about that. As I certainly am no teen. I know my grandson couldn't take them he was knocking boxes all over the stores off the shelves by mistake. So the pdoc did remove him from all medication. But that is only one person. He has defiant personality so maybe don't know ad's do not work for this condition. So for about five years he's med free. Phillipa
Posted by Phillipa on September 9, 2007, at 18:36:31
In reply to Please be sensitive » Phillipa, posted by Deputy 10derheart on September 9, 2007, at 11:12:35
Reread again can't use an I word as I take ad's????Phillipa
Posted by sam123 on September 9, 2007, at 21:57:31
In reply to Re: News - Antidepressants Vindicated? » sam123, posted by linkadge on September 9, 2007, at 13:43:45
>
> I am not going to argue that antidepressants don't work, because that is impossble, but I can argue that placebos work as well as antidepressants in most clinical trials becuase that is fact based.
>And yet in the real world suicide rates for teens and children are at the highest rates in more than a decade during a period where prescribing AD's for this age group declined.
Posted by Schess81 on September 10, 2007, at 0:25:56
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
What I have come to believe is that anti-depressants are a brilliant(and maybe even beneficial) way to package and sell the placebo effect; as long as we have a medical establishment that generally believes that these substances have an effect on the biology of depression, the lay person who trusts his doctor will always have a chance to benefit from the drug. Not because the AD actually targets the correct biological source of the depression, but because of his faith in modern medicine hes likely to benefit from a genuine placebo effect regardless.
What I believe Link is simply trying to argue is that if all popular ADs in the world were secretly replaced with sugar pills and no one was aware, the success rates of these pills would continue be the same. (Some comprehensive, impartial studies of big pharmas drug trials seem to imply this)
Now the deal with the black box- less people are taking their ADs; (placebo pills, if you will, for the sake of arguement) Because they are afraid of the suicidal side effects, they miss out on the placebo therapy they might have received had they taken the drugs. In other words, according to the data, it could be argued that the while the ADs might increase suicides in some cases, the incidence of the placebo effect is far greater and is preventing far more suicides.
This is not an argument that Major Depression is not biological or a genetically predisposed condition- it clearly is in my opinion. The question is whether these popular drugs are the result of weak science and biased drug company research, which is also part of what Linkage is trying to debate.
Unfortunately, the pharmaceutical industry may be actually stifling true innovation in the treatment of depression by endlessly developing "me too" drugs who's trials can easily be manipulated to show satisfactory effectiveness. They have been following the same paradigm for the last few decades with no real improvement in drug effectiveness- according to clinical trial data, new drugs are no more effective that the older tricyclics and such. Not only that, but no matter how different the modes of action are on these different drugs, when the trials come out they all seem to perform about the same...
All in all, I guess we are probably better off without the black box labels on our ADs [or prescription placebos- if I can call them that :p]
Posted by sam123 on September 10, 2007, at 0:57:59
In reply to Depends on your point of view, posted by Schess81 on September 10, 2007, at 0:25:56
My personal experience is that AD's are very effective, For me the improvement is dramatic.
Posted by Deputy 10derheart on September 10, 2007, at 1:03:57
In reply to Re: Please be sensitive » Deputy 10derheart, posted by Phillipa on September 9, 2007, at 17:32:27
Posted by Deputy 10derheart on September 10, 2007, at 1:12:53
In reply to Re: Please be sensitive » Deputy 10derheart, posted by Phillipa on September 9, 2007, at 18:36:31
> Reread again can't use an I word as I take ad's????
I'm not sure what you're asking me here, but the issue wasn't so much with making an "I" statement, but with characterizing adults who do/don't take [less] ADs, as smarter, or not smarter.....even if you are including yourself in the group.
Hope that helps. - Deputy 10derHeart
Posted by Deputy 10derheart on September 10, 2007, at 1:28:08
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:52:27
>>You are skating on thin ice, consider what you say in yout zeel to answer every post.
Please don't post anything that could lead others to feel accused or put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
10derHeart, acting as deputy for Dr. Bob
Posted by sam123 on September 10, 2007, at 10:44:43
In reply to Re: News - Antidepressants Vindicated? » jrbecker76, posted by Larry Hoover on September 9, 2007, at 14:12:13
>
> I think the figures are compelling.
>
> Lar
>Thanks Lar, yes very compelling. Wow, a 49% increase in sucide rates in the Netherlands
while SSRI prescriptions for youths decreased
by approximately 22% in both the United States and the Netherlands.Results:
SSRI prescriptions for youths decreased
by approximately 22% in both
the United States and the Netherlands after
the warnings were issued. In the Netherlands,
the youth suicide rate increased
by 49% between 2003 and 2005 and
shows a significant inverse association
with SSRI prescriptions. In the United
States, youth suicide rates increased by
14% between 2003 and 2004, which is the
largest year-to-year change in suicide
rates in this population since the Centers
for Disease Control and Prevention began
systematically collecting suicide data in
1979.Conclusions:
In both the United States
and the Netherlands, SSRI prescriptions
for children and adolescents decreased
after U.S. and European regulatory agencies
issued warnings about a possible suicide
risk with antidepressant use in pediatric
patients, and these decreases were
associated with increases in suicide rates
in children and adolescents.
Posted by polarbear206 on September 10, 2007, at 12:09:38
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 10, 2007, at 10:44:43
>
> >
> > I think the figures are compelling.
> >
> > Lar
> >
>
> Thanks Lar, yes very compelling. Wow, a 49% increase in sucide rates in the Netherlands
> while SSRI prescriptions for youths decreased
> by approximately 22% in both the United States and the Netherlands.
>
>
>
> Results:
> SSRI prescriptions for youths decreased
> by approximately 22% in both
> the United States and the Netherlands after
> the warnings were issued. In the Netherlands,
> the youth suicide rate increased
> by 49% between 2003 and 2005 and
> shows a significant inverse association
> with SSRI prescriptions. In the United
> States, youth suicide rates increased by
> 14% between 2003 and 2004, which is the
> largest year-to-year change in suicide
> rates in this population since the Centers
> for Disease Control and Prevention began
> systematically collecting suicide data in
> 1979.
>
> Conclusions:
> In both the United States
> and the Netherlands, SSRI prescriptions
> for children and adolescents decreased
> after U.S. and European regulatory agencies
> issued warnings about a possible suicide
> risk with antidepressant use in pediatric
> patients, and these decreases were
> associated with increases in suicide rates
> in children and adolescents.
>
>I am not surprised at all this was going to happen. It was just a matter of time. Yes, the evidence was very compelling. Such a tragedy of young lives lost!
Polarbear
Posted by linkadge on September 10, 2007, at 14:06:09
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 21:57:31
>And yet in the real world suicide rates for >teens and children are at the highest rates in >more than a decade during a period where >prescribing AD's for this age group declined.
That doesn't mean anything yet. Only time will tell if one is actually causing the other. I'm sure the rate of prescriptions to adults has declined a bit too, has there been a corresponding increase in adult suicide?
Like I said before, there could a reverse plaecbo effect at work wherby the precieved loss of a effective treatment is increasing depression.
In order to truely determine if antidepressants are infact reducing suicde rates there would need to be a double blind placebo controlled study on the likelyhood of suicide, which is unlikely to happen due to ethics.
Linkadge
Posted by linkadge on September 10, 2007, at 14:07:37
In reply to Depends on your point of view, posted by Schess81 on September 10, 2007, at 0:25:56
>hat I have come to believe is that anti-
>depressants are a brilliant(and maybe even >beneficial) way to package and sell the placebo >effect; as long as we have a medical >establishment that generally believes that these >substances have an effect on the biology of >depression, the lay person who trusts his doctor >will always have a chance to benefit from the >drug. Not because the AD actually targets the >correct biological source of the depression, but >because of his faith in modern medicine hes >likely to benefit from a genuine placebo effect >regardless.
Thats *exactly* my argument. The increased rate of suicide may more reflect a loss of faith in modern medicine.Linkadge
Posted by linkadge on September 10, 2007, at 14:20:38
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 10, 2007, at 10:44:43
>Wow, a 49% increase in sucide rates in the >Netherlands
>while SSRI prescriptions for youths decreased
>by approximately 22% in both the United States >and the Netherlands.But does't that kind of favor my point though? Why does the increase in rate of suicide exceed the rate of drop in prescriptions?
One would need to know if the individuals who were killing themselves were ones who were previously taking antidepressants?
These numbers say to me that there are more people killing themselves than those who were taken off drugs. If it is the drug that was preventing the suicides, then one would expect that the increase in suicides to essentially correspond to those who are no longer being prescribed antidepressants, not more.
So what is accounting for this extra margin? Probably what I am describing.
The fact that it is more says to me that the loss of faith due of medical treatments is extending to those on the drugs as well as off the drugs.
As well, the loss of hope for those who were considering treatment is a big deal.
Linkadge
Posted by linkadge on September 10, 2007, at 14:22:31
In reply to Re: News - Antidepressants Vindicated?, posted by polarbear206 on September 10, 2007, at 12:09:38
Its not compelling at all (IMHO).
Check back in a year and the suicide rate will level out regardless. Suicide rates only adjust like this to abrupt changes in things. You know, stock market crash etc.
Linkadge
Posted by sam123 on September 10, 2007, at 14:41:05
In reply to Re: News - Antidepressants Vindicated?, posted by linkadge on September 10, 2007, at 14:22:31
It is too bad more people have to die to prove what seems clear to some people.
Posted by linkadge on September 10, 2007, at 19:22:25
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 10, 2007, at 14:41:05
>It is too bad more people have to die to prove >what seems clear to some people.
If it only seems clear to some people, then it is only clear to some people that they are dying for that particular reason.
Linkadge
Posted by jhj on September 11, 2007, at 8:08:39
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
I am fascinated by the statements and arguments made here by none other then devil's advocate.Sample the collection here.but I can argue that placebos work as well as antidepressants in most clinical trials becuase that is fact based.
In order to truely determine if antidepressants are infact reducing suicde rates there would need to be a double blind placebo controlled study on the likelyhood of suicide, which is unlikely to happen due to ethics.
Suicide rates only adjust like this to abrupt changes in things. You know, stock market crash etc.
These statements can be interpreted as funny only if they are not on such a sensitive topic and read by people suffering for years due to depression.FDA and health authorities should ban antidepressant immediately if according to statement II of above "facts have proved that placebo work as well as antidepressant".
Posted by sam123 on September 11, 2007, at 12:41:05
In reply to Re: News - Antidepressants Vindicated?, posted by jhj on September 11, 2007, at 8:08:39
>
> I am fascinated by the statements and arguments made here by none other then devil's advocate.Sample the collection here.
>
I find the right AD's, for me, to be anything but a placebo. They have been very effective for more than a decade. I know what happens when I go off,
I know when one does not work or I hit one the works. The difference is that dramatic.Link argues AD's are no better than placebo, that is his experience.
I am seeing improvement far past placebo response and there are posters here who have been on AD's a long time and find they do work.
Posted by Jamal Spelling on September 11, 2007, at 13:42:46
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 11, 2007, at 12:41:05
My own opinion is that, if SSRIs were indeed nothing more than glorified placebos, then surely they should all be equally useful or useless when administered to any particular individual. And yet, most of us who have used SSRIs will attest that, in our own particular case, certain SSRIs work much better than others. For example, my own experience has been that sertaline works much better for me than citalopram. How is that possible if both were merely placebos? Shouldn't I then have benefited equally from both of them?
Jamal
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