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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 53. Go back in thread:
Posted by doxogenic boy on October 19, 2013, at 17:01:15
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 19, 2013, at 16:27:34
> Inactivity is very bad for mental disorders. Being without a job for a long time will
> undoubtedly worsen depression, so if the antidepressants pacify it could end up being a trap.Correction " ... so if the antidepressants make people passive and apathetic, it could end up being a trap."
- doxogenic
Posted by linkadge on October 19, 2013, at 17:02:29
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 19, 2013, at 16:06:20
I'm not a sleep expert, but I think nightmares are due to some sort of cholinergic / monoaminergic imbalance. The brain is trying to process emotional content without being in a paralyzed state(?). It is certainly not rejuvenating to be having constant nightmares. Its probably as unhealthy as apnea.
Linkadge
Posted by doxogenic boy on October 19, 2013, at 17:14:00
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 17:02:29
> I'm not a sleep expert, but I think nightmares are due to some sort of cholinergic / monoaminergic imbalance. The brain is trying to process emotional content without being in a paralyzed state(?). It is certainly not rejuvenating to be having constant nightmares. Its probably as unhealthy as apnea.
Thanks for your reply. I did a simple search for SSRIs and nightmares, and it gave lots of relevant results:
https://www.google.no/search?num=100&safe=off&site=&source=hp&q=ssri+nightmares- doxogenic
Posted by linkadge on October 19, 2013, at 17:16:23
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by doxogenic boy on October 19, 2013, at 16:27:34
Dopamine increases the motivation to act. Serotonin (ie. SSRIs) counteracts this. SSRIS decrease the motivation and drive to act or achieve things. Correspondingly SSRIs can decrease feelings of guilt associated with being inactive or unproductive.
Deep sleep is needed to help reorient an individual to long term goals and aspirations. One could easily loose a decade or more on SSRIs. One would be perfectly content watching Seinfeld and making peanut butter sandwiches for a decade (been there done that).
Throw in some money for being disabled and away we go.This is not to trivialize some people's situations as I know some people really are sick. However, I feel like there is a growing segment of the population that just need a steady job and some strong coffee.
Linkadge
Posted by baseball55 on October 19, 2013, at 19:05:00
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 17:16:23
Who says ADs suppress REM sleep? Where is the evidence? I never experienced that.
And who says that ADs make people passive and lazy? That was not my experience at all. Depression made me unproductive, unmotivated and unable to function normally. Successful treatment with ADs put me back to work again.
Also, where's the evidence for tardive dysphoria? Besides a few anecdotes?
Posted by sigismund on October 19, 2013, at 19:26:34
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 12:11:46
>Heres a better idea. Lower the minimum wage to create more jobs and force employers to offer and unlimited supply of cocaine leaves for chewing on the job. Your employees will stay fit and sharp, develop fewer metabolic symptoms and are guaranteed to keep coming to work.
Just the coca leaves. They really work.
How about some old fashioned protection for US jobs? Those Bangladeshi children are overworked.
Posted by linkadge on October 19, 2013, at 20:20:35
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by baseball55 on October 19, 2013, at 19:05:00
Do a google search for REM sleep + SSRI, you should get may hits. SSRIs make tons of people apathetic and lazy.
Linkadge
Posted by linkadge on October 19, 2013, at 20:35:30
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by sigismund on October 19, 2013, at 19:26:34
I agree with you about American protectionism. Unfortunately, I believe, we are witnessing the beginning of the fall of the US empire. Our living standards will continue to fall, as those of individuals in third world countries rise. We consume more than we produce. We borrow money from China to buy things from China that we neither need nor can afford.
We are witnessing other countries copy the 1900's US style of economic growth. Jobs will continue to leave the country and the US will continue to print money. Eventually China will catch on that is never going to get its money back. At this stage, the US will be unable to finance its debt. Interest rates will skyrocket and the typical western debt driven consumption model will implode.
Buy gold and get the hell out of the US dollar!
Linkadge
Posted by Phillipa on October 19, 2013, at 20:56:09
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 20:35:30
I agree and also going to renew my passport so I can get out of Dodge for real. Phillipa
Posted by sigismund on October 19, 2013, at 21:39:24
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 20:35:30
I'm in favour of eliminating structural rigidities from the drug market, and improving labour productivity there too.
My coca has to come here from Peru via the US.
Sliced white, I love it.
Posted by doxogenic boy on October 20, 2013, at 11:43:20
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by baseball55 on October 19, 2013, at 19:05:00
> And who says that ADs make people passive and lazy?
There is some information here:
http://www.dr-bob.org/tips/split/SSRIs-and-apathy.htmlMessages about SSRI-induced apathy on dr-bob.org:
https://www.google.no/search?hl=en&as_q=ssri+apathy&as_epq=&as_oq=&as_eq=&as_nlo=&as_nhi=&lr=&cr=&as_qdr=all&as_sitesearch=dr-bob.org&as_occt=any&safe=images&tbs=&as_filetype=&as_rights=- doxogenic
Posted by SLS on October 22, 2013, at 6:34:23
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by linkadge on October 19, 2013, at 17:16:23
> Dopamine increases the motivation to act. Serotonin (ie. SSRIs) counteracts this. SSRIS decrease the motivation and drive to act or achieve things.
Is this true of SSRIs even when they produce a robust antidepressant response, or is this associated only with non-response? I don't doubt that SSRI-induced apathy and amotivation are acute effects, but what happens after receptor desensitization occurs? Wouldn't these unwanted effects dissipate?
I don't know, of course.
- Scott
Posted by SLS on October 22, 2013, at 6:38:25
In reply to Re: Irving Kirsch, placebos and antidepressants » Phillipa, posted by doxogenic boy on October 19, 2013, at 7:02:52
> I found this diagnosis in DSM-5:
> "Persistent complex bereavement disorder: This disorder is characterized by severe and persistent grief and mourning reactions"
>
> Do they prescribe antidepressants for this in America?I believe so. Columbia / New York State Psychiatric Institute has been studying this for at least a year.
- Scott
Posted by doxogenic boy on October 22, 2013, at 8:36:39
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by SLS on October 22, 2013, at 6:38:25
> > I found this diagnosis in DSM-5:
> > "Persistent complex bereavement disorder: This disorder is characterized by severe and persistent grief and mourning reactions"
> >
> > Do they prescribe antidepressants for this in America?
>
> I believe so. Columbia / New York State Psychiatric Institute has been studying this for at least a year.Have they found evidence that antidepressants work for this diagnosis? Are the patients satisfied?
- doxogenic
Posted by doxogenic boy on October 22, 2013, at 8:45:25
In reply to Re: Irving Kirsch, placebos and antidepressants » linkadge, posted by SLS on October 22, 2013, at 6:34:23
> > Dopamine increases the motivation to act. Serotonin (ie. SSRIs) counteracts this. SSRIS decrease the motivation and drive to act or achieve things.
>
> Is this true of SSRIs even when they produce a robust antidepressant response, or is this associated only with non-response? I don't doubt that SSRI-induced apathy and amotivation are acute effects, but what happens after receptor desensitization occurs? Wouldn't these unwanted effects dissipate?
--Isn't SSRI-induced apathy a long-term side effect of SSRIs?
See this study:
http://www.ncbi.nlm.nih.gov/pubmed/12019662
Excerpt from the abstract above:
J Clin Psychiatry. 2002 May;63(5):391-5.
Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.
Marangell LB, Johnson CR, Kertz B, Zboyan HA, Martinez JM.
SourceMood Disorders Center, Department of Psychiatry, Baylor College of Medicine, Houston, Tex 77030, USA. laurenm@bcm.tmc.edu
Abstract
BACKGROUND:We report a clinical trial of olanzapine in the treatment of prominent apathy in the absence of depression in patients on long-term treatment with selective serotonin reuptake inhibitors (SSRIs) for nonpsychotic major depression.
[...]
CONCLUSION:These preliminary data suggest that olanzapine may be effective in treating apathy syndrome in nonpsychotic patients taking SSRIs.
End quote.Do you know of patients with SSRI-induced apathy that have been helped with atypical antipsychotics?
- doxogenic
Posted by SLS on October 22, 2013, at 11:30:29
In reply to Re: Irving Kirsch, placebos and antidepressants » SLS, posted by doxogenic boy on October 22, 2013, at 8:45:25
This is good. Thanks.
Lauren Marangell is a respectable academician.
- Scott> > > Dopamine increases the motivation to act. Serotonin (ie. SSRIs) counteracts this. SSRIS decrease the motivation and drive to act or achieve things.
> >
> > Is this true of SSRIs even when they produce a robust antidepressant response, or is this associated only with non-response? I don't doubt that SSRI-induced apathy and amotivation are acute effects, but what happens after receptor desensitization occurs? Wouldn't these unwanted effects dissipate?
> --
>
> Isn't SSRI-induced apathy a long-term side effect of SSRIs?
>
> See this study:
> http://www.ncbi.nlm.nih.gov/pubmed/12019662
> Excerpt from the abstract above:
> J Clin Psychiatry. 2002 May;63(5):391-5.
> Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.
> Marangell LB, Johnson CR, Kertz B, Zboyan HA, Martinez JM.
> Source
>
> Mood Disorders Center, Department of Psychiatry, Baylor College of Medicine, Houston, Tex 77030, USA. laurenm@bcm.tmc.edu
> Abstract
> BACKGROUND:
>
> We report a clinical trial of olanzapine in the treatment of prominent apathy in the absence of depression in patients on long-term treatment with selective serotonin reuptake inhibitors (SSRIs) for nonpsychotic major depression.
> [...]
> CONCLUSION:
>
> These preliminary data suggest that olanzapine may be effective in treating apathy syndrome in nonpsychotic patients taking SSRIs.
> End quote.
>
> Do you know of patients with SSRI-induced apathy that have been helped with atypical antipsychotics?
>
> - doxogenic
Posted by doxogenic boy on October 22, 2013, at 11:46:43
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by SLS on October 22, 2013, at 11:30:29
Thanks for your reply.
Here is a case report which indicates that dose reduction can help for SSRI-induced apathy.
http://www.ncbi.nlm.nih.gov/pubmed/21240154
Psychopharmacol Bull. 2010;43(4):76-9.
Antidepressant induced apathy responsive to dose reduction.
Kodela S, Venkata PD.
SourceCarilion Clinic-Virginia Tech Psychiatry Residency Program, Roanoke, VA, USA. sreekant.kodela@googlemail.com
AbstractApathy has a significant negative impact on the quality of life. It can be a part of other axis I and axis III disorders such as depression. It has also been reported as a treatment emergent side effect of SSRI drugs. A 48 year old male with diagnosis of personality change due to medical condition and depressive symptoms was started on Sertraline. Although his depressive symptoms, impulse control and his irritability improved significantly he became quite apathetic. This responded positively to a reduction in the dose of sertraline. Since apathy can be a residual symptom of depression it may be a valid consideration to increase the dose of the SSRI. However if apathy was not a significant part of depressive syndrome prior to SSRI treatment then antidepressant treatment emergent apathy needs to be considered and one option is to reduce the dose of the SSRI. Other options appear to be addition of other pharmacological agents such as stimulants, dopamine agonists, acetylcholinesterase inhibitors and NMDA antagonists.
- doxogenic
Posted by babbler20 on October 30, 2013, at 21:57:56
In reply to Re: Irving Kirsch, placebos and antidepressants » Phillipa, posted by doxogenic boy on October 18, 2013, at 11:03:52
> > Same thing my pdoc said that even in his opinion that ad's are more of a placebo effect. That life circumstances play more a role. Also the hope of the patient that "well now I have a med I am better".
>
> Could you ask your pdoc what he thinks about Irving Kirsch's claims about antidepressants and placebo, as mentioned is this thread? Do the mental health professionals in the United States discuss this topic a lot? I am very curious about what psychiatrists say about this.
>
> The placebo effect is part of the effect of every treatment for any disease. (I have never heard of a treatment that does not have a placebo effect in addition to the pharmacological effect.)
>
> I have read earlier in Scientific American Mind that the reason for the high placebo responses in drug studies for antidepressants in the United States, is that some of/lots of patients in the studies weren't depressed in the first place. (I think they got money for participating in the studies.) Therefore the placebo response looks higher than it is. What do you think about this?
>
> - doxogenicDoxogenic,
I actually hadn't considered the fact that many of the patients that were given the placebo weren't depressed. This is an excellent point !
Posted by doxogenic boy on November 2, 2013, at 9:14:04
In reply to Re: Irving Kirsch, placebos and antidepressants, posted by babbler20 on October 30, 2013, at 21:57:56
> > I have read earlier in Scientific American Mind that the reason for the high placebo responses in drug studies for antidepressants in the United States, is that some of/lots of patients in the studies weren't depressed in the first place. (I think they got money for participating in the studies.) Therefore the placebo response looks higher than it is. What do you think about this?
> Doxogenic,
>
> I actually hadn't considered the fact that many of the patients that were given the placebo weren't depressed. This is an excellent point !Yes, I think the pharmaceutical companies will take this into consideration in future trials/research, because they obviously lose money when they get too high placebo responses. So maybe the Kirsch/placebo debate took place on false premises?
Here is an overview of that debate:
http://web.archive.org/web/19990128083252/http://journals.apa.org/prevention/
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0050045
http://ebmh.bmj.com/content/11/3/66.full
- doxogenic
Posted by larryhoover on November 2, 2013, at 22:23:38
In reply to Irving Kirsch, placebos and antidepressants, posted by doxogenic boy on October 18, 2013, at 8:23:17
Kirsch is a man who selects his data to match his hypothesis, manipulating the data until the stats say what he wishes them to say, IMHO.
It was a while ago, when I wrote this, but I haven't changed my mind.
http://www.dr-bob.org/babble/20080221/msgs/815551.html
Lar
Posted by rockerchick46 on November 3, 2013, at 1:52:39
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by larryhoover on November 2, 2013, at 22:23:38
Hi Larry.
Thank you.
- Scott
Posted by rockerchick46 on November 3, 2013, at 6:56:16
In reply to Re: Irving Kirsch, placebos and antidepressants » larryhoover, posted by rockerchick46 on November 3, 2013, at 1:52:39
> Hi Larry.
>
> Thank you.
>
>
> - ScottI'm defintely not Scott :-)
Posted by doxogenic boy on November 4, 2013, at 12:26:10
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by larryhoover on November 2, 2013, at 22:23:38
> Kirsch is a man who selects his data to match his hypothesis, manipulating the data until the stats say what he wishes them to say, IMHO.
>
> It was a while ago, when I wrote this, but I haven't changed my mind.
>
> http://www.dr-bob.org/babble/20080221/msgs/815551.htmlI have read your message from 2008 with interest. I am no expert, so I can't contradict any of your findings. Do you know of more articles (from psychologist or psychiatrists) with critical analyses of Kirsch's claims about antidepressants? My interest into this is because of a general interest in psychiatry and because I use psychotropic drugs myself.
- doxogenic
Posted by larryhoover on November 4, 2013, at 22:55:52
In reply to Re: Irving Kirsch, placebos and antidepressants » larryhoover, posted by doxogenic boy on November 4, 2013, at 12:26:10
> Do you know of more articles (from psychologist or psychiatrists) with critical analyses of Kirsch's claims about antidepressants? My interest into this is because of a general interest in psychiatry and because I use psychotropic drugs myself.
>
> - doxogenicYou'll also find links to some very cogent critical reviews of Kirsch referenced within this article.
Here's a much more useful analysis of similar data reported upon by Kirsch:
http://www.nice.org.uk/nicemedia/pdf/cg023fullguideline.pdfA re-analysis of Kirsch's data, showing he misreported his results:
http://www.ncbi.nlm.nih.gov/pubmed/20800012Lar
Posted by doxogenic boy on November 6, 2013, at 17:57:31
In reply to Re: Irving Kirsch, placebos and antidepressants » doxogenic boy, posted by larryhoover on November 4, 2013, at 22:55:52
> > Do you know of more articles (from psychologist or psychiatrists) with critical analyses of Kirsch's claims about antidepressants? My interest into this is because of a general interest in psychiatry and because I use psychotropic drugs myself.
> >
> > - doxogenic
>
> You'll also find links to some very cogent critical reviews of Kirsch referenced within this article.
>
> http://blogs.plos.org/mindthebrain/2012/12/26/the-antidepressant-wars-a-sequel-how-the-media-distort-findings-and-do-harm-to-patients/
>
> Here's a much more useful analysis of similar data reported upon by Kirsch:
> http://www.nice.org.uk/nicemedia/pdf/cg023fullguideline.pdf
>
> A re-analysis of Kirsch's data, showing he misreported his results:
> http://www.ncbi.nlm.nih.gov/pubmed/20800012
Thank you very much, this was new information for me. I have found some more:http://www.ncbi.nlm.nih.gov/pubmed/19588448
Quote from the link above:
Cochrane Database Syst Rev. 2009 Jul 8;(3):CD007954. doi: 10.1002/14651858.CD007954.
Antidepressants versus placebo for depression in primary care.
Arroll B, Elley CR, Fishman T, Goodyear-Smith FA, Kenealy T, Blashki G, Kerse N, Macgillivray S.
SourceDepartment of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Abstract
BACKGROUND:Concern has been expressed about the relevance of secondary care studies to primary care patients specifically about the effectiveness of antidepressant medication. There is a need to review the evidence of only those studies that have been conducted comparing antidepressant efficacy with placebo in primary care-based samples.
OBJECTIVES:To determine the efficacy and tolerability of antidepressants in patients (under the age of 65 years) with depression in primary care.
SEARCH STRATEGY:All searches were conducted in September 2007.The Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Controlled Trials Register was searched, together with a supplementary search of MEDLINE, PsycINFO, EMBASE, LILACS, CINAHL and PSYNDEX. Abstracts of all possible studies for inclusion were assessed independently by two reviewers. Further trials were sought through searching the reference lists of studies initially identified and by scrutinising other relevant review papers. Selected authors and experts were also contacted.
SELECTION CRITERIA:Studies were selected if they were randomised controlled trials of tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) versus placebo in adults. Older patients (over 65 years) were excluded. Patients had to be recruited from a primary care setting. For continuous outcomes the Hamilton Depression scale of the Montgomery Asberg Scale was requred.
DATA COLLECTION AND ANALYSIS:Data were extracted using data extraction forms by two reviewers independently, with disagreements resolved by discussion. A similar process was used for the validity assessment. Pooling of results was done using Review Manager 5. The primary outcome was depression reduction, based on a dichotomous measure of clinical response, using relative risk (RR), and on a continuous measure of depression symptoms, using the mean difference (MD), with 95% confidence intervals (CI).
MAIN RESULTS:There were fourteen studies (16 comparisons) with extractable data included in the review, of which ten studies examined TCAs, two examined SSRIs and two included both classes, all compared with placebo. The number of participants in the intervention groups was 1364 and in the placebo groups 919. Nearly all studies were of short duration, typically 6-8 weeks. Pooled estimates of efficacy data showed an RR of 1.24, 95% CI 1.11-1.38 in favour of TCAs against placebo. For SSRIs this was 1.28, 95% CI 1.15 to 1.43.. The numbers needed to treat (NNT) for TCAs ranged from 7 to 16 {median NNT 9} patient expected event rate ranged from 63% to 26% respectively) and for SSRIs from 7 to 8 {median NNT 7} (patient expected event rate ranged from 48% to 42% respectively) . The numbers needed to harm (NNH for withdrawal due to side effects) ranged from 4 to 30 for TCAs (excluding three studies with no harmful events leading to withdrawal) and 20 to 90 for SSRIs.
AUTHORS' CONCLUSIONS:Both TCAs and SSRIs are effective for depression treated in primary care.
End quote.
----------------------------
http://www.ncbi.nlm.nih.gov/pubmed/22033583Quote from the link above:
Eur Arch Psychiatry Clin Neurosci. 2011 Nov;261 Suppl 3:207-45. doi: 10.1007/s00406-011-0259-6.
General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA section of pharmacopsychiatry.
Baghai TC, Blier P, Baldwin DS, Bauer M, Goodwin GM, Fountoulakis KN, Kasper S, Leonard BE, Malt UF, Stein D, Versiani M, Möller HJ; Section of Pharmacopsychiatry, World Psychiatric Association.
Collaborators (46)
SourceDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian-University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany. Thomas.Baghai@medbo.de
AbstractCurrent gold standard approaches to the treatment of depression include pharmacotherapeutic and psychotherapeutic interventions with social support. Due to current controversies concerning the efficacy of antidepressants in randomized controlled trials, the generalizability of study findings to wider clinical practice and the increasing importance of socioeconomic considerations, it seems timely to address the uncertainty of concerned patients and relatives, and their treating psychiatrists and general practitioners. We therefore discuss both the efficacy and clinical effectiveness of antidepressants in the treatment of depressive disorders. We explain and clarify useful measures for assessing clinically meaningful antidepressant treatment effects and the types of studies that are useful for addressing uncertainties. This includes considerations of methodological issues in randomized controlled studies, meta-analyses, and effectiveness studies. Furthermore, we summarize the differential efficacy and effectiveness of antidepressants with distinct pharmacodynamic properties, and differences between studies using antidepressants and/or psychotherapy. We also address the differential effectiveness of antidepressant drugs with differing modes of action and in varying subtypes of depressive disorder. After highlighting the clinical usefulness of treatment algorithms and the divergent biological, psychological, and clinical efforts to predict the effectiveness of antidepressant treatments, we conclude that the spectrum of different antidepressant treatments has broadened over the last few decades. The efficacy and clinical effectiveness of antidepressants is statistically significant, clinically relevant, and proven repeatedly. Further optimization of treatment can be helped by clearly structured treatment algorithms and the implementation of psychotherapeutic interventions. Modern individualized antidepressant treatment is in most cases a well-tolerated and efficacious approach to minimize the negative impact of otherwise potentially devastating and life-threatening outcomes in depressive disorders.
End quote.
-----------------------------------
http://www.ncbi.nlm.nih.gov/pubmed/23552610
Quote from the link above:Psychol Med. 2013 Apr 3:1-11. [Epub ahead of print]
Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis.
Cuijpers P, Turner EH, Mohr DC, Hofmann SG, Andersson G, Berking M, Coyne J.
SourceDepartment of Clinical Psychology, VU University Amsterdam, The Netherlands.
Abstract
BACKGROUND:The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo. Method Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges' g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses.
RESULTS:The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14-0.36, I 2 = 0%, 95% CI 0-58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00-12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size.
CONCLUSIONS:Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.
End quote.- doxogenic
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Script revised: February 4, 2008
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