On 12 December 2006 Paul Okami wrote:
Excuse me Allen, *you* not I supported the contention
that major depression is a "pseudo-entity"-something
I most certainly do *not* believe. Here is
your quote, favorably quoting from Parker et al:
"Here are a few quotes from an article by Parker et al (2003).
made in relation to the Kirsch et al (2002) article that Paul
cites, and specifically to their writing that "the pharmacological
effects of antidepressants are clinically negligible". He cites
problems with the studies under review by Kirsch et al:
"First, the current classification model. Creating pseudo-entities
such as 'major depression' for use as the principal 'diagnostic'
measure increases the chance of non-differential results
between interventions."
Paul has completely misread the quotation I provided from Parker et al
(2002). Parker wrote: "First the classification model...Creating
pseudo-entities such as 'major depression' for use as the principal
'diagnostic' measure increases the chance of non-differential results
between interventions."
Clearly Parker is criticizing the [DSM] classification model for
diagnostic purposes, in which "major depression" is classified as a
separate entity, along with other supposed entities representing
psychiatric syndromes. He is not saying that major depression (without the
quote marks) is a pseudo-entity -- which could indeed be taken to imply a
sceptical view of such psychiatric disorders leading to the conclusion
that it doesn't matter if the medications work or not. The fact that
Parker obviously *does care* about this, apart from the fact that he is
clearly writing about the current diagnostic "classification model" and
refers to 'major depression' within quotes in this specific context,
suffices to show that in no sense is he saying that major depression as
such is a pseudo-entity as taken by Paul.
I think that Paul's interpretation of Parker's words is so misconceived
that I can be forgiven for misinterpreting his position. It simply didn't
enter my head that he could be alluding to what he took to be *Parker's*
position, so discrepant is it with the view that Parker actually holds.
Paul wrote:
I believe that mental suffering is very real, that it clusters
in groups of symptoms that may often overlap, and
that current treatments are inadequate. That's it, and all
I have to say on the topic at this time.
If that's all Paul was saying there would have been little disagreement.
No one disputes that current treatments are inadequate, i.e., that there
is not room for a very large amount of improvement in the treatment of
psychiatric disorders in clinical practice.
Incidentally, in addition to Quitkin et al's (2000) closely argued
rebuttal to the contentions of Kirsch and Sapirstein's (1998)
meta-analysis and similar contentions, Robyn M. Dawes (author of *House of
Cards: Psychology and Psychotherapy Built on Myth*) makes points that lead
to his saying that "The logic of Kirsch and Sapirstein is thus seriously
flawed." This is not to say Quitkin and Dawes are necessarily right (the
discussion involves great complexities for the non-expert), only that
those who take Kirsch et al's claims as definitive should recognize that
it is no more so than any other research on studies of this nature - even
if New York Times journalists et al treat it as such.
http://content.apa.org/journals/pre/1/1/5
See also Donald F. Klein, "Listening to meta-analysis but hearing bias."
http://content.apa.org/journals/pre/1/1/6
On 12 December Rike Koenigsberg wrote [snip]:
Since much of the discussion has been focused on the fact that
antidepressants don't work...
That should read that much of the discussion has been focused on the
*claim* that antidepressants don't work.
On 12 December Paul Brandon wrote, quoting a letter in the NYT on a
cholesterol drug [snip]:
On the general topic of proving drug safety and effectiveness,
this letter to the editor in the NYT a couple of days ago might be
interesting:
You refer to "me too" drugs as offering "a merely incremental
advance over some existing therapy," but there is no reason to
think that they offer any advance at all.
In the clinical trials required for approval by the Food and Drug
Administration, manufacturers do not have to compare "me too"
drugs with old drugs in the same class, only with placebos.
For all we know, then, each new "me too" drug may be worse
than existing ones.
In the case of psychiatric disorders, it is widely recognized (and much
written about) that the older tricyclics are generally at least as
effective as the newer SSRIs (though the specific disorder must also be
taken into account). The reason that SSRIs are usually preferred is that
they have fewer, and more easily tolerated, side effects.
Allen Esterson
Former lecturer, Science Department
Southwark College, London
http://www.esterson.org/
-----------------------------------
Tue, 12 Dec 2006 08:28:01 -0500
Author: "Paul Okami" <[EMAIL PROTECTED]>
Subject: Re: SSRIs and depression and anxiety
Excuse me Allen, *you* not I supported the contention that major
depression
is a "pseudo-entity"--something I most certainly do *not* believe. Here
is
your quote, favorably quoting from Parker et al:
"Here are a few quotes from an article by Parker et al (2003) [Parker is
the lead author of one of the articles I previously referenced], made in
relation to the Kirsch et al (2002) article that Paul cites, and
specifically to their writing that "the pharmacological effects of
antidepressants are clinically negligible". He cites problems with the
studies under review by Kirsch et al:
"First, the current classification model.Creating pseudo-entities such as
'major depression' for use as the principal 'diagnostic' measure
increases
the chance of non-differential results between interventions."
Once again, and for the last time: I believe that mental suffering is
very
real, that it clusters in groups of symptoms that may often overlap, and
that current treatments are inadequate. That's it, and all I have to say
on
the topic at this time.
Paul Okami
Tue, 12 Dec 2006 08:02:54 EST
Author: [EMAIL PROTECTED]
Subject: Re: SSRIs and depression and anxiety
Last weeks issue of Time Magazine, with cover date 14/4/06, has an
article
The year in medicine A to Z. One of the entries is
DEPRESSION
Researchers still don't understand why severely depressed teenagers are
more
likely than adults to commit suicide while taking antidepressant drugs
like
Paxil, but a major study out of UCLA concluded that the drugs do more
good
than harm. Starting in the early 1960s, the annual U.S. suicide rate
held fairly
steady at 12 to 14 instances per 100,000--until 1988, when the first of
a
new generation of antidepressants, the selective serotonin reuptake
inhibitors,
was introduced. The suicide rate has been falling ever since, to around
10
per 100,000. The investigators estimate that nearly 34,000 lives have
been
saved.
Since much of the discussion has been focused on the fact that
antidepressants don't work, how would you explain this result?
Riki Koenigsberg
[EMAIL PROTECTED]
Tue, 12 Dec 2006 13:19:20 -0600
Author: Paul Brandon <[EMAIL PROTECTED]>
Subject: Re: SSRIs and depression and anxiety
On the general topic of proving drug safety and effectiveness, this
letter to the editor in the NYT a couple of days ago might be
interesting:
Re "Collapse of a Cholesterol Drug":
You refer to "me too" drugs as offering "a merely incremental advance
over some existing therapy," but there is no reason to think that
they offer any advance at all.
In the clinical trials required for approval by the Food and Drug
Administration, manufacturers do not have to compare "me too" drugs
with old drugs in the same class, only with placebos.
For all we know, then, each new "me too" drug may be worse than existing
ones.
The answer is for Congress to authorize the F.D.A. to require new
drugs to be compared head to head with old ones.
Marcia Angell, M.D.
Cambridge, Mass., Dec. 5, 2006
The writer, a senior lecturer in social medicine at Harvard Medical
School, was an editor in chief of The New England Journal of Medicine.
* PAUL K. BRANDON [EMAIL PROTECTED] *
* Psychology Dept Minnesota State University *
* 23 Armstrong Hall, Mankato, MN 56001 ph 507-389-6217 *
* http://krypton.mnsu.edu/~pkbrando/ *
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