Posted by Jamal Spelling on January 6, 2008, at 11:46:13
In reply to What is so controversial here?, posted by Phoenix1 on January 6, 2008, at 11:00:11
There seem to be two schools of thought on STAR*D. Some see it as a win for psychiatry, because it shows a 67% remission rate for depression using standard psychiatric devices. Others see a study that shows how, in the real world, only 30% of depression patients who take citalopram will remit within 14 weeks, and only 47% of patients will show a clinical response to the drug. This means that, more often than not, users of citalopram will neither remit, nor even show a clinical response to the drug.
And even though the study was not designed to test the efficacy of citalopram, with numbers like these, it raises serious questions about how citalopram fares against placebo.
So you have this multi-billion dollar industry, where tens-of-millions of people around the world are being prescribed these drugs, and these drugs do have problematic side-effects, and the question is: do these drugs really even work? Are they the best way to treat depression? Could there be more efficaceous and safer treatment alternatives?
Meta-analyses seem to indicate that SSRIs do work better than placebo, but only just, and only with a bit of wishful thinking.
So the question is, when faced with a depression patient, does a doctor treat the patient according to the STAR*D algorithm? Well, if you're happy with numbers like 30% and 67%, then yes. But some of us think these numbers are not good enough.
So 30 years ago, the fatality rate in general anesthesia was of the order 1 in 10,000. A combination of bad publicity and legal action forced the anesthesiology profession and industry to improve how they did things, and today the fatality rate is of the order 1 in 300,000.
And I think that in a similar way, psychiatry has to be held accountable to higher standards. Compared to other medical sciences, the state of psychiatry is poor, bordering at times on pseudoscientific. And you might say - but they are doing their best - and I'll say that, where you have pharmaceutical companies like Eli Lilly misrepresenting the safety data of Prozac and Zyprexa, or Warner-Lambert misrepresenting the efficacy data of Neurontin - clearly the industry is not doing enough.
So, the controversy is that STAR*D exposes the disappointing real-world success of psychiatry.
I believe that a comprehensive approach to treating depression may include medication, but should also include some form of counseling. And the fact is that, if your life is a mess, you're going to be depressed regardless of receiving medication. But of course, doctors don't tell you that. Most people just get a prescription for some SSRI and are left to their own devices after that. And after a while, you are referred to a psychiatrist, who starts experimenting on you with more exotic drugs, and this narrow-minded prescription-milling sometimes carries on for years, all the while the broader scope of your depression is ignored.
poster:Jamal Spelling
thread:804126
URL: http://www.dr-bob.org/babble/20080105/msgs/804632.html