Chad Clark's Open Journal : 2010-02-02

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February 02, 2010 :
1) Antidepressants often as effective as placebos.

Sharon Begley and Sarah Kliff at Newsweek commented that placebos and
antidepressants are both effective 75% of the time.  The article raises the
question of whether patients should be informed that there is no difference
in effectiveness.

The Newsweek article references the The Journal of the American Medical
Association (JAMA).  This month JAMA published Antidepressant Drug Effects
and Depression Severity with the following conclusion (bold emphasis added
by me):

   The magnitude of benefit of antidepressant medication compared with
   placebo increases with severity of depression symptoms and may be
   minimal or nonexistent, on average, in patients with mild or moderate
   symptoms. For patients with very severe depression, the benefit of
   medications over placebo is substantial.

As a side note Newsweek also noted:

  But if experts know that antidepressants are hardly better than placebos,
  few patients or doctors do. Some doctors have changed their prescribing
  habits, says Kirsch, but more "reacted with anger and incredulity."

That reminded me of a chapter from Mistakes were made (but not by me) by
Tavris and Aronson.  That book is worth reading.

On another side note Newsweek also noted:

  Consider how research on drugs works. Patient volunteers are told they
  will receive either the drug or a placebo, and that neither they nor the
  scientists will know who is getting what. Most volunteers hope they get
  the drug, not the dummy pill. After taking the unknown meds for a while,
  some volunteers experience side effects. Bingo: a clue they're on the
  real drug. About 80 percent guess right, and studies show that the worse
  side effects a patient experiences, the more effective the drug. Patients
  apparently think, this drug is so strong it's making me vomit and hate
  sex, so it must be strong enough to lift my depression. In clinical-trial
  patients who figure out they're receiving the drug and not the inert
  pill, expectations soar.

Certainly an interesting point to consider about studies.



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