?On 9 March 2010 Stephen Black wrote: >We recently concluded a heated debate on whether anti- >depressants are truly effective relative to placebo, with >recent research claiming that they are not both supported >and disputed by TIPSters.
Having posted a long piece on this only a month ago I really don't want to get caught up in it again, but the terms in which Stephen expresses the above implicitly treats depression as if it can be discussed as a single entity. In the words of Gordon Parker of the School of Psychiatry at the University of New South Wales: "A low threshold for diagnosing clinical depression, however, risks normal human emotional states being treated as illness, challenging the model's credibility and risking inappropriate management.[…] Depression is a diagnosis that will remain a non-specific 'catch all' until common sense brings current confusion to order. As the American journalist Ed Murrow observed in another context: 'Anyone who isn't confused doesn't really understand the situation'." "Is depression overdiagnosed? Yes." BMJ 2007;335:328 (18 August): http://www.bmj.com/cgi/content/full/335/7615/328 In my 8 February post I dealt with this point, but here is Lewis Wolpert, professor of biology at University College London, giving just a glimmer of what full-blown clinical depression is like: "In the hierarchy of pain, [Wolpert] believes his illness was worse than witnessing in 1997 the death from breast cancer of his beloved second wife, Jill Neville, the Australian writer. 'I am ashamed to admit that my depression felt worse than her death,' he writes, 'but it is true. I was in a state that bears no resemblance to anything I had experienced before'." http://tinyurl.com/yzcucc4 The following pertains to Margaret Tebbit, wife of a Conservative Party cabinet minister who was crippled when an IRA bomb brought down a considerable part of the hotel in which Government ministers were staying during a Party conference in 1984. Her injuries left her severely paralysed and confined to a wheelchair, but I heard her on the radio a few years ago saying her experience of a lengthy period of post-natal depression was worse than her current situation. Here she is interviewed by the Daily Telegraph last year: "Even after 25 years of coping with spinal injury, Lady Tebbit says the fear and confusion she experienced after William’s birth were worse than anything since. 'I think I have been very fortunate that the depression hasn’t returned; mental and physical illnesses are very different things, so you can’t really weigh them up and compare them, but I do think I had more to contend with then than I do now,' she says." http://tinyurl.com/yklykrz Any discussion of "depression" that doesn't distinguish between full-blown clinical depression and the far more common kinds of experiences for which anti-depressants are prescribed nowadays is failing to address an essential aspect of the issue. Allen Esterson Former lecturer, Science Department Southwark College, London [email protected] http://www.esterson.org ------------------------------------------------------------ [tips] Anti-depressants vs placebo: more on sblack Tue, 09 Mar 2010 08:02:51 -0800 We recently concluded a heated debate on whether anti- depressants are truly effective relative to placebo, with recent research claiming that they are not both supported and disputed by TIPSters. Here's another possibility to explain why anti-depressants tend not to do well in placebo-controlled trials (unless you take the position that they in fact are effective relative to placebo and studies showing otherwise are shoddy and forgettable). Placebos are getting stronger. In other words, the failure of anti- depressants to show benefit relative to placebo is not due to poorer performance of the drugs, but to improved performance of placebos. This, I guess, is good news, although not necessarily for the drug industry. A new (and yet another) meta-analysis of anti-depressant response vs placebo reports this as one of its findings. Rief et al (2009) found that "the effect sizes in placebo groups in 2005 were more than twice as great as those in 1980", indicating a substantial increase in placebo effectiveness. But note that this was only for observer ratings rather than for patient reports. An interesting question is why. Possibly patients have greater confidence in the anti-depressant cure these days but, if this was the reason, one would expect that the effect would also occur for patient reports, probably to an even greater extent. National Public Radio in the U.S. has an article on the finding here: http://www.npr.org/templates/story/story.php?storyId=12436705 8 or http://tinyurl.com/yfmkauy The growing power of the sugar pill (March 8, 2010) Source: Rief, W. et al (2009). Meta-analysis of the placebo response in antidepressant trials. Journal of Affective Disorders, 118, 1-8. Stephen -------------------------------------------- Stephen L. Black, Ph.D. Professor of Psychology, Emeritus Bishop's University e-mail: sblack at ubishops.ca 2600 College St. Sherbrooke QC J1M 1Z7 Canada --- You are currently subscribed to tips as: [email protected]. To unsubscribe click here: http://fsulist.frostburg.edu/u?id=13090.68da6e6e5325aa33287ff385b70df5d5&n=T&l=tips&o=1173 or send a blank email to leave-1173-13090.68da6e6e5325aa33287ff385b70df...@fsulist.frostburg.edu
