Wednesday, April 8, 2020

Comments by Ken

Showing 5 of 5 comments.

  • Someone of 1boringoldman’s blog suggested that less efficacy in children could be the result of children “breaking blind” less often than adults, with the result that they are subject to the placebo effect to a *greater* extent than adults. This may be because they realize less often than adults that they are being given a placebo, because they are less aware of the tip-offs–for example, the parents may be informed of potential side effects while children are left out of the loop on that.

  • I wonder if someone can clarify something for me.

    From the summary above: “positive responses to SSRI antidepressant treatments for depression … drop to “minimal” after just four weeks”

    And from the abstract: “Treatment gains in pediatric MDD are greatest early in treatment and are on average minimal after 4 weeks of SSRI pharmacotherapy in pediatric MDD.”

    Does that mean subjects initially got “better” (by whatever measure the study used) and then got worse, so that by around 4 weeks they were minimally “better” than at zero weeks; or does it mean that subjects initially got “better” and then at around 4 weeks they continued to “improve” only minimally?

    Thanks for any help. -Ken

  • Hi, Jeffrey. Thanks very much for your reply to my comment. Personally, I agree with you that the benefit (if any) does not outweigh the side effects, in many or perhaps all cases. It’s just that I’m not sure this study really provides a straightforward argument for that conclusion, as I’d hoped when I first saw the headline on this Web site.

    Advocates of these drugs might say that the outcomes would be even worse without the drugs, and the study really has nothing to say about that. The authors even cite a study that they claim shows that mortality is higher without the drugs.

    But it certainly is interesting that investigators seemed so shocked at the extent of the side effects, adverse events, and drug discontinuation. And it’s certainly a welcome admission that psychiatry might be overstating the benefits and understating the risks.

  • Since this study was designed to compare the four atypicals to each other–there was no placebo group (“because of ethical considerations”)–I have a hard time understanding how the investigators reached a conclusion about efficacy. They say there was no “significant improvement in psychopathology” at follow up, but at baseline an unspecified number of patients were already on an atypical, if I understand the paper correctly.

    So supporters of the use of these drugs could claim that no improvement is to be expected, since the drug benefits were effected before baseline, and thereafter the drugs simply maintained the prior level of benefit.

    Can someone help me understand this better? Thanks. -Ken