On 30 September Stephen Black wrote: > Allen's point [despite a disclaimer] does depend on the assumption > that Prozac is more effective than placebo for depression. If true, > then certainly withholding Prozac in favour of a sugar pill would > lead to adverse effect.
I don't want to get bogged down in semantics, but I don�t see that my argument depended on the assumption of that Prozac is more effective than placebo for depression. I emphasised that the nature of the situation meant we were dealing with hypotheticals, and argued that *if* (no assumption that it does, just the possibility) Prozac is more effective than a sugar pill then it would not be the case that taking a sugar pill has no adverse effects (keeping in mind that I was arguing that, from the point of view of someone suffering from severe depression, no positive result is very much an "adverse" effect if the Prozac alternative may have had such a result). It seems to me perfectly valid to take no definite view, but put an "if...then" argument. If, as Stephen thinks, this is assuming Prozac is more effective than a sugar pill, then Stephen�s argument that a sugar pill placebo has no adverse effects (in the wider sense I spelled out) likewise assumes that Prozac is no more effective than a sugar pill. It seems to me that each of us is arguing "if...then", which does not preclude keeping open all possibilities. Allen E. -------------- Thu, 30 Sep 2004 10:18:20 -0500 Author: "Stephen Black" <[EMAIL PROTECTED]> Subject: Re: SSRIs > On 30 Sep 2004, Allen Esterson wrote: > > > > > I agree with Stephen that it would have been valuable to study the effec= > ts > > of CBT with a placebo, but not when he writes says that giving CBT with = > a > > sugar pill would be =93without risk of adverse effects=94. It may well b= > e with > > some severely depressed patients that there would be adverse effects of > > not prescribing Prozac (or another SSRI), namely the continuation of > > excruciating symptoms beyond what might have occurred had Prozac been > > used. (It=92s the nature of the situation that the discussion here deals > > with hypotheticals.) > > Allen's point [despite a disclaimer] does depend on the assumption > that Prozac is more effective than placebo for depression. If true, > then certainly withholding Prozac in favour of a sugar pill would > lead to adverse effect. In the very recent TADS study of adolescents > diagnosed with major depression I referred to in my previous post > (March et al, 2004), Prozac alone was no more effective than placebo > over the 12 weeks of treatment (although it was on "supportive > contrasts on the week 12 adjusted means"). The effectiveness of SSRIs > vs placebo is currently a contentious issue, notwithstanding the > review cited by Allen of Donald Klein and his associates in favour of > the drug. > > > On Stephen=92s remark that =93it raises the interesting question whether= > all > > behaviour therapy would go better with a placebo pill=94, it may well be= > a > > good idea to include this component among the alternatives in many > > studies. But it should be remembered that CBT is used for a number of > > rather different mental disorders/illnesses. Would it be sensible to tre= > at > > someone with bipolar disorder, when suicide is a very real risk in the > > depressive phase, with CBT plus a placebo when there is good evidence th= > at > > lithium is effective in controlling the symptoms? > > No, not when such evidence exists and when it is considered > appropriate that the drug be prescribed. What I'm suggesting is that > when a decision is made to treat someone with behaviour therapy alone > (without a drug), it wouldn't hurt to tell the patient something like > this: "I'm also going to ask a doctor to prescribe a pill for you > which can sometimes be very helpful for people undergoing therapy. We > don't really understand how it works but I can assure you that it's > very safe and has no side effects." Then arrange for them to receive > a placebo. Actually, I think we could use a good study on this > issue, something which the TADS study could have done but didn't. > > (But as my wife pointed out, this wouldn't work for me. I'd want to > know the name of the pill, and then research it on the web!) > > Stephen > > > March, J. et al (2004). Fluoxetine, cognitive-behavioral therapy, and > their combination for adolescents with depression, JAMA, 292, 807-- > ___________________________________________________ > Stephen L. Black, Ph.D. tel: (819) 822-9600 ext 2470 > Department of Psychology fax: (819) 822-9661 > Bishop's University e-mail: [EMAIL PROTECTED] > Lennoxville, QC J1M 1Z7 > Canada > > Dept web page at http://www.ubishops.ca/ccc/div/soc/psy > TIPS discussion list for psychology teachers at > http://faculty.frostburg.edu/psyc/southerly/tips/index.htm > _______________________________________________ --- You are currently subscribed to tips as: [EMAIL PROTECTED] To unsubscribe send a blank email to [EMAIL PROTECTED]
