Posted by Robert_Burton_1621 on February 24, 2015, at 10:58:12
In reply to Re: Effexor + Mirtazapine MORE effective than PARNATE! » vanvog, posted by SLS on March 12, 2013, at 8:36:26
>this particular arm of the STAR*D study is meaningless.
>
> "The mean daily dose at exit for tranylcypromine was 36.9"
>
> The low dosage of Parnate used was woefully inadequate to treat depression. Most people don't respond to Parnate until a dosage of 40 - 80 mg/day is reached.
>
> http://ajp.psychiatryonline.org/article.aspx?articleID=98116
>> - Scott
Note that the citation in the AJP which Scott links to includes both a letter from critics attributing the cause of the 'disappointing' results regarding tranylcypromine to the sub-therapeutic mean dosage used, and a reply by the authors (McGrath et al) of the venlafaxine plus mirtazapine vs tranylcypromine study, which entirely *endorses* the critical observations contained in that letter.
McGrath explains that the study was not permitted to use dosages beyond the maximum recommended by the FDA, thus they were stuck with a clinically negligible comparator of 36.9 mg of tranylcypromine against a clinically sufficient regime of ven + mirtazapine. It's hardly surprising, then, that a clinical regime was found in its therapeutic effects to be superior to a sub-clinical one. Scott's description of the study as "meaningless" is therefore entirely accurate, as the authors themselves concede (but in a separate, brief note written only subsequent to the publication of their paper).
poster:Robert_Burton_1621
thread:1040126
URL: http://www.dr-bob.org/babble/20150223/msgs/1077059.html