![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 61 to 85 of 116. Go back in thread:
Posted by bulldog2 on April 19, 2008, at 13:26:29
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 13:02:49
I believe that the AD effect of maois was found by accident. The first maoi was an antibiotic given to people with TB.It was noticed that their mood was significantly boosted by the drug.This cannot be explained away by placebo effect when this drug was being used for TB and no one had reason to expect an AD effect.
Now this may have no relevance to any other class of AD drugs but it does point us in the direction that it is possible for drugs to have benefit in the treatment of depression and other mood disorders.
Now it is my belief that you still treat the entire body and be as healthy as you can be. That's proper diet, exercise, and treating any hormonal problems etc. It's just my feeling that meds can be a useful adjunct in the battle against depression.
Since this is a forum for a discussion of meds I just feel once you believe that meds don't work it's time to move on. It may be a valid conclusion for your depression. If I reached that conclusion I would not post that here.Someone may stop their meds or not start them and I don't want to be responsible for the consequences which could be devastating for that person.I may not believe that chemotherapy works and that natural alternatives are better but I wouldn't go into a forum for chemotherapy and start a thread on how chemo doesn't work.
Posted by Larry Hoover on April 19, 2008, at 13:33:57
In reply to OOOOOOOOOOOOooooooooo, posted by Betula on April 19, 2008, at 3:41:34
> Hello all!
>
> Its great we have an open debate about these sorts of things.I'll restrict my commentary to debate.
> Here is the link to the webpage of the lead author of that article:
>
> http://psy.hull.ac.uk/Staff/i.kirsch/
>
> So. I'm going to make some points.
>
> 1) One paper doesn't prove a theory - it takes quite a few for something to become universally accepted.Then why did you conclude that your proposition was "FACT", and on the basis of but one publication?
Science doesn't prove things. Scientific proof is a fallacy. Science *disproves* things. Science is advanced on falsification. What is left is either consistent or inconsistent with hypotheses or theories.
> 2) The author is a PROFESSOR at a large civic university in the UK. (note its harder to become a professor in the UK - there doesn't exist sub categories such as 'assistant professor' etc as there does in other countries.)We are not debating Kirsch, but the quality of his arguments.
> I doubt any of us here are actual professors.
And how do you come to believe that? You know nothing of the qualifications possessed by members of this anonymous group.
> He has quite a distinguished publication record - again, something I'm sure none of any of us have.
Again, how do you know? And how does prior publication come to bear on an analysis of this one?
> 3) The paper got published in a reputable, peer reviewed journal.
That's debatable, on its face. We're not talking about JAMA, BMJ, Lancet, Science, Nature et al. It got published, period.
> That means that it was reviewed by other academics working in precisely the same field as him. They must have thought it acceptable for publication, otherwise, it would be sent to the trash.
You have an entirely naive belief in what transpires during peer review. Primarily, it is a search for errors, or blatant inconsistencies among the hypothesis, method, data, results, and conclusions. It is not an assessment of the "value" of the work.
> And it took a year from submission to acceptance, so that would imply it had a couple of revisions at least.
Not necessarily. And one year is very typical.
> So the peer reviewers would have been doing their job properly.
That is a gross fallacy. Here are what a couple of experts in peer review have stated (from wiki):
"Drummond Rennie, deputy editor of Journal of the American Medical Association is an organizer of the International Congress on Peer Review and Biomedical Publication, which has been held every four years since 1986. He remarks, 'There seems to be no study too fragmented, no hypothesis too trivial, no literature too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate, too obscure, and too contradictory, no analysis too self-serving, no argument too circular, no conclusions too trifling or too unjustified, and no grammar and syntax too offensive for a paper to end up in print.'"
"Richard Horton, editor of the British medical journal The Lancet, has said that, 'The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability not the validity of a new finding. Editors and scientists alike insist on the pivotal importance of peer review. We portray peer review to the public as a quasi-sacred process that helps to make science our most objective truth teller. But we know that the system of peer review is biased, unjust, unaccountable, incomplete, easily fixed, often insulting, usually ignorant, occasionally foolish, and frequently wrong.'"
Note the statement that peer review does not assess validity. Peer review is merely the beginning of the process of scrutiny. Validity is determined by the world at large, not an editorial board or peer review committee. You will note that my critique depended heavily on issues of validity, which Kirsch et al failed to even discuss.
> 4) The journal the paper appeared in, PLoS Medicine. Journals do not want to lose money.
Relevance? It certainly has no bearing on scientific validation, in any case.
> The reputation of a journal (and also of the authors for that matter) quickly goes down the drain if they publish something that is trash.
Indeed. As I earlier stated, it is perhaps relevant to consider that the paper was *not* published by BMJ, JAMA, Lancet, NEJM, Science, Nature or other top tier journals.
> Other academics quickly see through fudged results etc.
No, they do not. Fudged data cannot be assessed by any review mechanism. Failure to replicate is usually the beginning of such challenges. It certainly cannot be determined by peer review.
> This means that journals select the very best papers they can. Therefore, I highly doubt that this paper is 'flawed' in any way.
I'll address flaws (other than those I found) momentarily.
> 5) Therefore I personally believe that this paper would not have been published if it were faulty/flawed/trash in any way. IT WAS PEER REVIEWED for heavens sake!
The idea that peer review should be the limit of critical review is absurd. What would you do with two papers, both peer reviewed, with absolutely contradictory and mutually exclusive results? It is incumbent on readers to engage critical thinking processes, which did *not* occur with this paper. Its conclusions were swallowed whole by the lay press (and some scientists, too), without aforethought.
> 6) I personally do not believe dismissals of the paper coming from people in general, unless they are a) the authors of the paper orYou expect the authors to diss themselves?!?
> b) suitably qualitifed academics working in the field i.e. the 'peers'. Its as simple as that.
Well, let's see what his peers have said, shall we? From the reviews appended to the original article, and BMJ:
"In conclusion, the paper of Kirsch and his colleagues presents nothing that was not previously known, but it does introduce empirically unsupported conclusions and erroneous interpretation that are potentially misleading."
Oh, I said the same things in my critique.
"Among other things, these applications have revealed that the misuse of ordinal scaled data can produce erroneous data and drive inaccurate conclusions. Consequently, concerns must be raised over the accuracy of the results of the meta-regression performed by Kirsch et al, given they have undertaken sophisticated mathematical operations on data which do not support such activities. Moreover, it is worth noting that even the calculation of a mean, a standard deviation, and a change score are invalid on ordinal data, given that these all assume equal interval scaling."
Translation: The statistical methods applied during the meta-analysis (of the ordinal Hamilton Depression Scale scores) are not meaningful. Ergo, any conclusions therefrom suffer from the same limitation.
"In each case the null hypothesis that the Kirsch et al estimator is unbiased has been tested and overwhelmingly rejected."
Re-analysis of Kirsch's methods demonstrate that his methodology negatively biased the outcomes.
And, even if one accepts the premise that these data are analyzable via this methodolgy, a recalculation under more rigorous procedures provides this outcome:
"If the weighted mean difference is used (an equally, or more valid approach given that all studies utilised the same outcome measure, namely the HRSD) effect sizes expressed in HRSD scores are larger than reported in this study (2.8 vs 1.8), and paroxetine and venlafaxine reach the NICE criteria for 'clinical significance' (HRSD change > 3)."
Aside, I had estimated the effect size plotted on Table 4 at about d=3, so I feel validated that my common-sensical critical-thinking test of Kirsch's stats is supported mathematically.
> 7) Of course, science evolves and develops and new things come to light, but at this time, I think that this paper is valid and the conclusions should be accepted into the bigger the scheme of things, including papers that show 'the drugs work'.
The paper is not valid. That was the point of my critique, and of other reviewers.
Appending your other post here:
> And oh, I meant to say, why is it so that people can not accept the conclusion of the paper?
It fails when subjected to critical thinking. I do not form conclusions about a paper until I have done so. As the paper fails on multiple fronts, its conclusions are irrelevant. I form my own conclusions.
> Does it challenge your world view in such a way that you simply have to deny the findings of it? Well, it would appear so.
My world view is totally unknown to you. In debate, it does not enter into the exposition in any way. I deny the findings because they are methodologically unsound. I deny the conclusions because they are not supported by the data. And I deny the external validity of the paper because it is not representative of the body of evidence available to me.
> Of course things are never black and white. This paper might be a complete and utter anomaly, (like I said before one paper doesn't really 'prove' anything) but that doesn't mean we can't consider it, relfect on it, and see that the authors may have some very good points.
I did not see any "very good points". If only he had similarly criticized psychotherapy, which has an apparent effect size against placebo of only 0.149, *way* below the NICE criterion.
J Consult Clin Psychol. 2003 Dec;71(6):973-9.
Establishing specificity in psychotherapy: a meta-analysis of structural equivalence of placebo controls.Baskin TW, Tierney SC, Minami T, Wampold BE.
Department of Counseling Psychology, University of Wisconsin-Madison, 53706, USA.Placebo treatments in psychotherapy cannot adequately control for all common factors, which thereby attenuates their effects vis-a-vis active treatments. In this study, the authors used meta-analytic procedures to test one possible factor contributing to the attenuation of effects: structural inequalities between placebo and active treatments. Structural aspects of the placebo included number and duration of sessions, training of therapist, format of therapy, and restriction of topics. Results indicate that comparisons between active treatments and structurally inequivalent placebos produced larger effects than comparisons between active treatments and structurally equivalent placebos: moreover, the latter comparison produced negligible effects, indicating that active treatments were not demonstrably superior to well-designed placebos.
> We shouldn't readily dismiss it because it challenges our beliefs.It has nothing to do with my beliefs. I didn't get that far.
If his evidence was sound (in my perhaps not so humble scientific opinion), I would say that.
> It makes me sad to see that people are so very narrow minded.
<Spock eyebrow>
> Goodday to everyone, and I'm leaving now.
Why? I thought you welcomed open debate.
> I do not want to inhabit a playground for people <snip>.
I cannot grasp the basis for this remark.
Lar
Posted by Larry Hoover on April 19, 2008, at 13:37:09
In reply to Re: They just don't work. FALLACY., posted by Shadowplayers721 on April 18, 2008, at 0:17:14
> Mr. Hoover, you did an exceptional job of reviewing this study. To be sure, it wasn't an easy task. I think that I read over this study at least four times.
Thank you!
I too read it a number of times, and I found his failure to overtly explain his statistical analytical decisions to be a severe limitation.
Kirsch has yet to answer his critics with respect to those decisions, at the online journal site. I think that speaks volumes.
Lar
Posted by Larry Hoover on April 19, 2008, at 13:37:45
In reply to Re: They just don't work. FALLACY., posted by SLS on April 18, 2008, at 5:30:46
> > Mr. Hoover, you did an exceptional job of reviewing this study.
>
> Larry's the man!
>
> We are indebted to him for his contributions.
>
>
> - Scott
You're too kind. Thanks.Lar
Posted by bulldog2 on April 19, 2008, at 13:48:44
In reply to Re: OOOOOOOOOOOOooooooooo, posted by Phillipa on April 19, 2008, at 13:24:00
> You know I feel as Racer does for different reasons. I feel like a total failure cause meds don't help me do the opposite of what they seem to do for others that they post. And for various reasons, age, money, physical conditions and I don't understand that article on thyroid. Guess I'm stupid. But my husband said if he knew I'd get sick which was when the thyroid condition started he would never have married me as he's younger. I warned him I would age faster than him. If my pdoc and others have said absolutely no to MAOI's I will listen to them and try to sort my thyroid endos and internists recommendations out first. And that is not easy the internist is an associate professor at Chapel Hill and the endos arent'. Internist says keep dose the same endo says lower it. So I'm in utter chaos. Can a med fix this. I say no. Sure it could drug me so I can't think can't anyway. And backpain is excruciating my guess is besides the degenerative discs and arthritis its anxiety. Uggg don't get old. Phillipa
The falacy in your argument is that your p-doc keeps you on the same regemin.Why did you stop the deplin as it has no sides? what was there to lose by staying on it? I think you may be confusing yourself.
Luvox + valium = status quo.
The combo is just not working. If pain is a big issue in your life you may need more than motrin. Pain can cause depression. Take care of your thyroid issues. Your p-doc should address your anxiety with different meds. Either more valium or something other med.Maybe low dose narcotics if your pain is severe. Even when your thyroid was okay you complained of severe anxiety and depression. You ride a bike so you also exercise. Anxiety and depression damage the body physically. I'm not saying you need an maoi but you need to do more than get your thyroid in balance. As Scott said the clock is ticking...
Posted by Larry Hoover on April 19, 2008, at 13:54:05
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 10:30:17
> I think the study that Betula brought up is very important, becase it is infact *not* just one study. It is a meta analysis of 47 other studies and the largest one of its kind to date. As mentioned it includes data that the drug companies conveniently left out which increases its validity beyond any one single study or any previous subgroup of *more positive* released trial data.
It is not data the drug companies left out. All of it was submitted to the FDA. Some of it was not published. That issue was already discussed at length, and you cannot lay the responsibility on just the drug companies. In the era in consideration, publication of negative studies almost never occurred. Moreover, negative studies teach us nothing, as we cannot discrimate between failed methodology and failed drug.
> Saying that Kirsh is biased only goes so far. If you are going to make a substantial argument that he has somehow biased this data than do so. I have not seen one person pose a good reason why his methodology is flawed in some way.
Funny, I thought I did all right.
> He was using standard methods of statistical analysis as far as I know, can you or anyone point to his flaws?
See my post entitled Re:debate.
> The clinical trial is unfortunately the only real way to scientifically establish the efficacy of antidepressants.
And Kirsch found statistically superiority of drugs over placebo, p <.001, including the "hidden" data. The new bar he held the old data up to was a novel and arbitrary standard of clinical significance, a test the original studies were not designed to meet. We don't take older cars off the road because they don't meet current emissions/efficiencies standards, so why should we retrospectively reassess these drugs based on data collected for other purposes? What he did is called data mining, and it is scientifically frowned upon. IMHO, he fished around until he found the statistics he liked, and he published those and those alone. A quick reference to the NICE document would show that to be the case.
Lar
Posted by SLS on April 19, 2008, at 14:17:44
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 13:02:49
Hi Linkadge.
:-)
Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
Remission is where it's at, baby. Remission.
:-)
Have a good life.
- Scott
Posted by bulldog2 on April 19, 2008, at 14:23:41
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by SLS on April 19, 2008, at 14:17:44
I have a med suggestion for Phillipe. Try neurontin. It can be good for anxiety, depression and pain. Kill three birds with one stone. For me it was weight neutral. Yes it worked for me! Now if your p-doc won't let you have neurontin fire her/him. Unlike maois you shouldn't have problems finding a p-doc or even a gp to prescribe it.
Posted by bulldog2 on April 19, 2008, at 14:26:08
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by SLS on April 19, 2008, at 14:17:44
> Hi Linkadge.
>
> :-)
>
> Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
>
> Remission is where it's at, baby. Remission.
>
> :-)
>
> Have a good life.
>
>
> - ScottScott
Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
Posted by SLS on April 19, 2008, at 14:35:31
In reply to Re: OOOOOOOOOOOOooooooooo, posted by bulldog2 on April 19, 2008, at 14:26:08
> > Hi Linkadge.
> >
> > :-)
> >
> > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> >
> > Remission is where it's at, baby. Remission.
> >
> > :-)
> >
> > Have a good life.
> >
> >
> > - Scott
>
> Scott
>
> Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
- Scott
Posted by SLS on April 19, 2008, at 14:37:33
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 19, 2008, at 14:35:31
> > > Hi Linkadge.
> > >
> > > :-)
> > >
> > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > >
> > > Remission is where it's at, baby. Remission.
> > >
> > > :-)
> > >
> > > Have a good life.
> > >
> > >
> > > - Scott
> >
> > Scott
> >
> > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
>
> I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
>
>
> - ScottThank God these people are not in a position of power. None of us would get well.
- Scott
Posted by bulldog2 on April 19, 2008, at 14:43:00
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 19, 2008, at 14:37:33
> > > > Hi Linkadge.
> > > >
> > > > :-)
> > > >
> > > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > > >
> > > > Remission is where it's at, baby. Remission.
> > > >
> > > > :-)
> > > >
> > > > Have a good life.
> > > >
> > > >
> > > > - Scott
> > >
> > > Scott
> > >
> > > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
> >
> > I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
> >
> >
> > - Scott
>
> Thank God these people are not in a position of power. None of us would get well.
>
>
> - ScottMisery truely loves company
Posted by bulldog2 on April 19, 2008, at 14:44:34
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 19, 2008, at 14:37:33
> > > > Hi Linkadge.
> > > >
> > > > :-)
> > > >
> > > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > > >
> > > > Remission is where it's at, baby. Remission.
> > > >
> > > > :-)
> > > >
> > > > Have a good life.
> > > >
> > > >
> > > > - Scott
> > >
> > > Scott
> > >
> > > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
> >
> > I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
> >
> >
> > - Scott
>
> Thank God these people are not in a position of power. None of us would get well.
>
>
> - Scotthave you found that nardil makes youn ravenous and have you gained weight on Nardil?
Posted by SLS on April 19, 2008, at 14:45:21
In reply to Re: OOOOOOOOOOOOooooooooo, posted by bulldog2 on April 19, 2008, at 14:43:00
> > > > > Hi Linkadge.
> > > > >
> > > > > :-)
> > > > >
> > > > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > > > >
> > > > > Remission is where it's at, baby. Remission.
> > > > >
> > > > > :-)
> > > > >
> > > > > Have a good life.
> > > > >
> > > > >
> > > > > - Scott
> > > >
> > > > Scott
> > > >
> > > > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
> > >
> > > I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
> > >
> > >
> > > - Scott
> >
> > Thank God these people are not in a position of power. None of us would get well.
> >
> >
> > - Scott
>
> Misery truely loves companySome people truly love misery.
- Scott
Posted by linkadge on April 19, 2008, at 14:48:09
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by Larry Hoover on April 19, 2008, at 13:54:05
>In the era in consideration, publication of >negative studies almost never occurred.
There you go.
>Moreover, negative studies teach us nothing, as >we cannot discrimate between failed methodology >and failed drug.
Oh, I see, we only pay attention to postitive trials. That makes a lot of sense.
>We don't take older cars off the road because >they don't meet current emissions/efficiencies >standards, so why should we retrospectively >reassess these drugs based on data collected for >other purposes?
Well, if that level of significance is enough for you then great.
>IMHO, he fished around until he found the >statistics he liked, and he published those and >those alone.
If that is your take.
Linkadge
Posted by linkadge on April 19, 2008, at 14:54:51
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by SLS on April 19, 2008, at 14:17:44
Seems to me that being on a message board on a glorious Saturday afternoon is a strange way to spend your remssion, but hey, whatever does it for you.
Linkadge
Posted by bulldog2 on April 19, 2008, at 14:57:17
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 14:48:09
> >In the era in consideration, publication of >negative studies almost never occurred.
>
> There you go.
>
> >Moreover, negative studies teach us nothing, as >we cannot discrimate between failed methodology >and failed drug.
>
> Oh, I see, we only pay attention to postitive trials. That makes a lot of sense.
>
> >We don't take older cars off the road because >they don't meet current emissions/efficiencies >standards, so why should we retrospectively >reassess these drugs based on data collected for >other purposes?
>
> Well, if that level of significance is enough for you then great.
>
> >IMHO, he fished around until he found the >statistics he liked, and he published those and >those alone.
>
> If that is your take.
>
> Linkadge
>This is my feeling...It it ain't broke don't fix it..Scott feels the best he has felt in years on Nardil so why tamper..I'd be ecstactic if I was him.
Posted by SLS on April 19, 2008, at 14:58:05
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 14:54:51
> Seems to me that being on a message board on a glorious Saturday afternoon is a strange way to spend your remssion, but hey, whatever does it for you.
>
>
> LinkadgeYou silly goose! I'm taking a break from my studies. I decided to enjoy my remission by returning to school.
- Scott
Posted by linkadge on April 19, 2008, at 15:01:32
In reply to Re: OOOOOOOOOOOOooooooooo, posted by bulldog2 on April 19, 2008, at 14:26:08
Actually, I am not bitter at all. I am feeling better than I ever have on meds.
I never knew that I needed to be on a stupifying, cardiotoxic, diabetogenic, carcinogenic, excitotoxic, neuroendocrine disruptor to be happy?
I learn something new every day.
Linkadge
Posted by bulldog2 on April 19, 2008, at 15:02:40
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 19, 2008, at 14:45:21
> > > > > > Hi Linkadge.
> > > > > >
> > > > > > :-)
> > > > > >
> > > > > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > > > > >
> > > > > > Remission is where it's at, baby. Remission.
> > > > > >
> > > > > > :-)
> > > > > >
> > > > > > Have a good life.
> > > > > >
> > > > > >
> > > > > > - Scott
> > > > >
> > > > > Scott
> > > > >
> > > > > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
> > > >
> > > > I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
> > > >
> > > >
> > > > - Scott
> > >
> > > Thank God these people are not in a position of power. None of us would get well.
> > >
> > >
> > > - Scott
> >
> > Misery truely loves company
>
> Some people truly love misery.
>
>
> - ScottCurrently doing deplin + Sam-e and getting a decent response thought not in remission. Could I get by with a lower dose of Nardil such as 45 mg. Also at lower doses is there less chance of a hypertensive crisis if I eat the wrong foods.
Posted by linkadge on April 19, 2008, at 15:09:36
In reply to Question For Scott, posted by bulldog2 on April 19, 2008, at 15:02:40
Seems to me that you were on the exact same combination of drugs and not feeling so hot less than a year ago.
Yes, I suppose it was indeed a delayed reaction of deplin. Thats sounds like a positive way to frame things.
Just keep changing it around and eventually things will go your way. Sounds like its just the way the wind blows.
But, as long as you have something to attribute it to. Thats what produces the sence of control over ones life.
But don't let me ruin it for you.
Linkadge
Posted by linkadge on April 19, 2008, at 15:11:23
In reply to Re: Question For Scott, posted by linkadge on April 19, 2008, at 15:09:36
Thats it for me folks. I just stopped by to say hi.
Good luck finding your answer.
Linkadge
Posted by SLS on April 19, 2008, at 15:13:16
In reply to Question For Scott, posted by bulldog2 on April 19, 2008, at 15:02:40
Hi Bulldog2.
This is conjecture:
> Currently doing deplin + Sam-e and getting a decent response thought not in remission.
Deplin can take 2-3 months to begin working. I think a brief "blip" response in the first week might indicate that things are heading in the right direction. Deplin produces an increase in S-AMe. Not only do I feel that the S-AMe is unecessary, it might even produce some dysphoria.
> Could I get by with a lower dose of Nardil such as 45 mg.
I would lower the dosage of Nardil only if you are having a difficult time tolerating side effects. I don't believe that you can lower an effective dosage of Nardil by adding Deplin.
> Also at lower doses is there less chance of a hypertensive crisis if I eat the wrong foods.
Sort of. The only thing is, this is probably at a dosage significantly lower than is necessary to maintain an antidepressant effect. In reality, it depends on the percentage of MAO being inhibited in the gut. I don't happen to know what the threshold is for reducing the tyramine reaction.
I apologize if I didn't get to your questions earlier.
- Scott
Posted by SLS on April 19, 2008, at 15:20:49
In reply to Re: Question For Scott, posted by linkadge on April 19, 2008, at 15:09:36
My Dearest Linkadge,
> Seems to me that you were on the exact same combination of drugs and not feeling so hot less than a year ago.
Nope.
> Yes, I suppose it was indeed a delayed reaction of deplin.Yup.
> Thats sounds like a positive way to frame things.
Yup.
> Just keep changing it around and eventually things will go your way.
Yup.
> Sounds like its just the way the wind blows.
Nope.
> But, as long as you have something to attribute it to.
Yup.
> Thats what produces the sence of control over ones life.
Yup. Remission of depression tends to restore one's control over life.
> But don't let me ruin it for you.You couldn't possibly.
- Scott
Posted by Larry Hoover on April 19, 2008, at 15:30:15
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 14:48:09
> >In the era in consideration, publication of >negative studies almost never occurred.
>
> There you go.So, how is that to be blamed on drug companies? The article that revealed this publication bias qualified its results by saying they could not determine if in fact that bias arose within the publication industry, or if the studies had never been submitted. Why do we never hear about this significant qualifier?
> >Moreover, negative studies teach us nothing, as >we cannot discrimate between failed methodology >and failed drug.
>
> Oh, I see, we only pay attention to postitive trials. That makes a lot of sense.That's not what I said. A finding of the null hypothesis could be due to there being no true difference to be found, or it could be a failure of the study methodology to detect a true difference. They cannot be distinguished from each other. As a result, such a study is considered to be a failed study, which serves only to guide further development of hypotheses and methodology. It doesn't show us anything else.
> >We don't take older cars off the road because >they don't meet current emissions/efficiencies >standards, so why should we retrospectively >reassess these drugs based on data collected for >other purposes?
>
> Well, if that level of significance is enough for you then great.Putting data to tests for which they were not collected always raises the issue of unexamined confounds. Again, post hoc analysis is only appropriate in further hypothesis development and testing, but not re-evaluation of the meaning of the data themselves.
> >IMHO, he fished around until he found the >statistics he liked, and he published those and >those alone.
>
> If that is your take.
>
> LinkadgeYes, it is. The NICE document showed a variety of tests of the antidepressant data, and Kirsch picked the weakest finding. For example, NICE found that: "There is strong evidence suggesting that there is a clinically significant difference favouring SSRIs over placebo on increasing the likelihood of patients achieving a 50% reduction in depression symptoms as measured by the HRSD (N = 1719; n = 3143; RR = 0.73; 95% CI, 0.69 to 0.78)." Not only did the statistic reach *clinical significance*, it was also rated as "strong evidence". I dismiss Kirsch both for what he said, and what he didn't say.
Refer to NICE for further definitions: http://www.nice.org.uk/guidance/index.jsp?action=download&o=29617
Here's an example of cherry-picking from NICE. This statistic dismisses the efficacy of CBT (cognitive behavioural therapy), when compared to *doing nothing at all*.
p. 123
"There is insufficient evidence to determine if there is a clinically significant difference between CBT and wait list control on increasing the likelihood of achieving remission as measured by the BDI (N = 1; n = 24; RR = 0.70; 95% CI, 0.41 to 1.20)."Acccording to this analysis, you are going to have a similar likelihood of achieving remission whether you receive CBT, or you remain on a wait-list for that therapy.
Of course, NICE presents a lot of other data, and statistics. I present this limited example to demonstrate how easy it is to bias conclusions. A critical analysis of the external validity of this finding would reveal that there is more to the story. And that's all I did when I trashed Kirsch.
Lar
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.