Study seeks to end antidepressant debate: the drugs do work

[S.J.B.]

That all drugs are better than placebo is true. However, there is a VERY important element to state here. The degree that anti-depressants are better than placebo IS NOT STATISTICALLY SIGNIFICANT.
For the null hypothesis to be rejected (The hypothesis that placebo is the cause of more positive anti-depressant effects than anti-depressents themselves) the observed result have to be statistically significant. And this is not the case - at least in the recently publiched studies I have read.

I haven't read the link in details yet but I will.

The conclusion of the meta-analysis discussed here is that all 21 antidepressants had a statistically-significant advantage over placebo.

 

[JessFR]

lol

I'm getting the feeling that the whole emphasis on cure as opposed to healing is a big part of what is fucking up the way modern Western medicine treats a lot of conditions, especially mental health and addiction related stuff.

My big problem is with the very term "western medicine".

To me there is only, scientific medicine, and unscientific medicine. The scientific medicine is mostly western medicine. And the unscientific medicine is mostly bullshit based on pseudoscience.

There's a little overlap, but not much. But hey, if you wanna believe in bullshit. Well then you'll go the way of Steve Jobs. To his credit he did eventually realize his mistake. But by then it was too late.

 

[aihfl]

To me there is only, scientific medicine, and unscientific medicine. The scientific medicine is mostly western medicine. And the unscientific medicine is mostly bullshit based on pseudoscience.

I agree with this. I'll occasionally see an acupuncturist for pain relief, but I have little belief that it does more than just make me feel better, and worst case scenario, people with serious conditions can eschew scientific medicine for some bogus holistic therapy to their detriment. I had a chiropractor tell me she could cure my depression and anxiety. Yeah right. What the hell does cracking my spine have to do with psychiatric/psychological issues?

There's a little overlap, but not much. But hey, if you wanna believe in bullshit. Well then you'll go the way of Steve Jobs. To his credit he did eventually realize his mistake. But by then it was too late.

What do you mean? Apple was wildly successful after Steve Jobs's return.

 

[JK25]

Hahaha that is what all SSRI's have been doing since the 60's.

 

[Cotcha Yankinov]

This is huge. In Britain they did the biggest meta-analysis of anti-depressants in history by looking at over 100,000 patients, covering 21 different drugs. All drugs were better than placebo, but most not by much. Only about 5 or 6 had "modest" results.

Some of the original meta analysis critical of antidepressants showed that antidepressants are only particularly effective (relative to placebo) in the severe depression category of patients - many people took this as a sign that people with mild and moderate depression should not be immediately thrown pills, and I believe that to be an accurate take-away from what we know about antidepressant risk vs. benefit ratios

 

[Cotcha Yankinov]

That all drugs are better than placebo is true. However, there is a VERY important element to state here. The degree that anti-depressants are better than placebo IS NOT STATISTICALLY SIGNIFICANT.
For the null hypothesis to be rejected (The hypothesis that placebo is the cause of more positive anti-depressant effects than anti-depressents themselves) the observed result have to be statistically significant. And this is not the case - at least in the recently publiched studies I have read.

One thing to consider from a statistical point of view (for chronic MDD patients) is the situation that medication X may only work for 1 out of 10 depression patients, and in the other 9 may cause e.g. a worsening of symptoms that would require the drug to be ceased. Looking at that drug X in isolation and just looking at the first 12 weeks of medication results per patient, it could appear as though it causes more harm than good at first glance.

But if we have 10 different medications that can work for 10 different aforementioned people, then they essentially would just need to be cycled through the meds until they each found their one. So a study of any one of those drugs could show that during the first 12 weeks, 9 patients had worsening symptoms/side effects/no improvement and only one person may have gotten better. Statistically, that looks horrible, until you look at the possible bigger picture, which is that each patient goes on to the next drug and the next until they find one that works for them. This includes alternative antidepressants such as Depakote as well.

Hopefully, each patient ends up being matched to an antidepressant, and thus what we really need is a meta analysis of our psychiatric/pharmacological methods of treating depression as a whole, rather than statistics on individual meds

What I would like to know in the future is what medicines (food, training, what ever) anti-depressant can be combined with in order to result in a bigger positive effect. At least this will be important to research until potentially new anti-depressants emerge that works different from SSRI's and SNRI's and works on something that actually have a significant effect.

Some research has shown promise for Antalarmin (stress hormone blocker) combined with SSRIs, mindfulness I'm sure would pair very well with SSRIs as well and cardio is known to augment SSRIs effects. In the severe depression category, a drug called pindolol seems to augment SSRI response as well, but only for the severely depressed

CY

 

[pofacedhoe]

why has no-one picked up on the fact that it includes old studies when ssri's were significant vs placebo along with modern ones where they have been show not to be thus diluting the new studies in a soup of old literature that isn't relevant because we live today and therefore today's people and their advertisement infected brains are the barometer for how effective they are today.

today isn't 1994

its a trick of data manipulation and statistics

 

[Cotcha Yankinov]

why has no-one picked up on the fact that it includes old studies when ssri's were significant vs placebo along with modern ones where they have been show not to be thus diluting the new studies in a soup of old literature that isn't relevant because we live today and therefore today's people and their advertisement infected brains are the barometer for how effective they are today.

today isn't 1994

its a trick of data manipulation and statistics

The depression inventory/metric used is important to consider - the old trials look better with regards to depression improvements rather than using the whole Hamilton depression inventory

https://www.ncbi.nlm.nih.gov/pubmed/25917369

"In total, 32 drug-placebo comparisons were reassessed. While 18 out of 32 comparisons (56%) failed to separate active drug from placebo at week 6 with respect to reduction in HDRS-17-sum, only 3 out of 32 comparisons (9%) were negative when depressed mood was used as an effect parameter (P<0.001).

The observation that 29 out of 32 comparisons detected an antidepressant signal from the tested SSRI suggests the effect of these drugs to be more consistent across trials than previously assumed. Further, the frequent use of the HDRS-17-sum as an effect parameter may have distorted the current view on the usefulness of SSRIs and hampered the development of novel antidepressants."

 

[pofacedhoe]

well to be fair i didn't even get that far inot the methodology

i still think they should compare ssri's to cannabis and opiates and placebo

when ur really depressed any old shit will lift u up a bit. there is nothing special about these ssri's

lots of drugs can dull your emotion until u dont care anymore