6 ms·

It's incorrect to say that grandparent's quote "not effective" is the same as your phrase "no effect whatsoever." The suggestion, following Irving Kirsch's boo

by rlucas 14y ago

It's incorrect to say that grandparent's quote "not effective" is the same as your phrase "no effect whatsoever." The suggestion, following Irving Kirsch's book, that the SSRIs are broadly "not effective," is a statement about the distribution of outcomes over a population. (It also takes into account the fact that even placebos cause changes in outcomes, and that we consider a drug not to be "effective" if its outcomes do not differ meaningfully from those attributable to placebos.) This is maybe better stated as "not efficacious" because we're talking about efficacy, vs. placebo, in a population. This is entirely different from the parent's (counterfactual) statement "the SSRI I'm taking has no effect whatsoever," which is an assertion about having any effect (not a relative effect vs. placebo) in a single individual (not a population). "Not effective"[as a vector operation and vs. a baseline established by placebo] != "has no effect whatsoever"[as a scalar operation and vs. a baseline of no intervention] Grandparent has most definitely not said that your perception of SSRI effects are "imagined," nor that you are "misguided." But you are arguing against a straw man until you at least acknowledge the distinctions here (which, it must be said, are pretty well explained in the book in question ;)

zzzeek 14y ago
Thanks for the language litigation, I'm now aware of the many subtle inaccuracies in my language, despite my skepticism that my real question was really so occluded. So here it is again: Is it your opinion that the popularity of SSRIs is misguided, and that their use would be better off discouraged, since they have been shown to be no more "effective" than placebo? That the vast majority of (or all?) patients who report "success" with SSRIs are simply experiencing an effect that could just as easily be delivered via sugar pill? Wikipedia's paragraph on this here (http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Depression http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_in...) has a decent summary of the current status. SSRIs have been shown, by two meta-analyses, to have a "clinically significant" effect for very severe depression, and a "statistically significant" effect for moderate depression, which is considered below the threshold of usefulness. The original poster's words were, "not effective for any type of depression". So will you correct this statement as well?
- Alex3917 14y ago
  Again, you need to read the book(s) if you want to understand the argument. The Wiki paragraph doesn't actually do a good job explaining much of anything.
  - zzzeek 14y ago
    Just wanting a simple yes or no. Or "not sure". SSRIs, pointless or not, in your opinion/fact-based-knowledge/divine-guidance/whatever. Thanks.
    - zzzeek 14y ago
      nevermind, I've reviewed enough of Kirsch's book and discussion of it at this point to see that it is virulently opposed to antidepressants and is cited broadly by various career opponents of psychiatry as well as a large number of lay-people troubled by the concept of depression as a medical illness. And as one would expect, often challenged by actual psychiatrists (but not always), focusing mostly on the inherently flawed state of measurement with regards to depression.
  - zzzeek 14y ago
    Particularly troubling is the lack of critical analysis that can be found regarding Kirsch's book. Googling for it reveals tons of links from various magazines and news sites with sensationalistic headlines, feeding into an emotion that is easy to tap, which is the discomfort many people have with the entire concept of antidepressants. "Going on antidepressants? Read this first!" that kind of thing. As for a formally written challenge to Kirsch, I could only find this times editorial http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepre... which makes the argument that someone in my position has already suspected, that the studies being cited are flawed - that it is exceedingly difficult to identify bona-fide "mildly or moderately depressed" people to participate in a study, not to mention that measuring depression is a completely subjective affair: > Often subjects who don’t really have depression are included — and (no surprise) weeks down the road they are not depressed. People may exaggerate their symptoms to get free care or incentive payments offered in trials. Other, perfectly honest subjects participate when they are at their worst and then spontaneously return to their usual, lower, level of depression. Without an objective means of measuring depression, measuring the effect of drugs objectively is not straightforward. Kirsch has, like everyone else, approached this study with a definite bias, a career based on raising the prominence of the placebo affect. I'm not sure you can read a few books and declare "the truth" as case closed here, all ideas are subject to challenge. In this case I think there's a lack of interest in challenging this idea as the drug companies are obviously doing quite well (and I am no fan of drug companies) and probably don't want to raise more attention to it. It's an extraordinary claim that the millions of people who insist that SSRIs are very effective for them are being deceived en-masse, and one under-critiqued meta-study might not be enough to prove that claim. Interesting comment on that article as well: > "Papers showing that antidepressants work had found their way into print; unfavorable findings had not." The point is, that there are any number of ways a clinical trial can be run such that an "effective" drug will not be able to demonstrate a level of statistical significance. While there is no way you can run a clinical trial so that an "ineffective" drug will demonstrate a level of statistical significance. If you run nine clinical trials that fail to show a drug is active, and one clinical trial that shows that it is active; when presented with this kind of data, most people in the general public would wrongly conclude that the drug is not active. In fact, the correct conclusion is that the drug is active. That is why it is the job of qualified experts at the FDA, and not the public, to examine the information generated from clinical trials and pass judgment as to whether or not a drug has been proved to be "safe and effective". If it were possible to make an ineffective drug demonstrate a level of statistical significance, then we'd have tons of studies proving the efficacy of homeopathy, wouldn't we ?

by rlucas 14y ago

zzzeek 14y ago

Thanks for the language litigation, I'm now aware of the many subtle inaccuracies in my language, despite my skepticism that my real question was really so occluded. So here it is again: Is it your opinion that the popularity of SSRIs is misguided, and that their use would be better off discouraged, since they have been shown to be no more "effective" than placebo? That the vast majority of (or all?) patients who report "success" with SSRIs are simply experiencing an effect that could just as easily be delivered via sugar pill? Wikipedia's paragraph on this here (http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Depression http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_in...) has a decent summary of the current status. SSRIs have been shown, by two meta-analyses, to have a "clinically significant" effect for very severe depression, and a "statistically significant" effect for moderate depression, which is considered below the threshold of usefulness. The original poster's words were, "not effective for any type of depression". So will you correct this statement as well?

Alex3917 14y ago
Again, you need to read the book(s) if you want to understand the argument. The Wiki paragraph doesn't actually do a good job explaining much of anything.
- zzzeek 14y ago
  Just wanting a simple yes or no. Or "not sure". SSRIs, pointless or not, in your opinion/fact-based-knowledge/divine-guidance/whatever. Thanks.
  - zzzeek 14y ago
    nevermind, I've reviewed enough of Kirsch's book and discussion of it at this point to see that it is virulently opposed to antidepressants and is cited broadly by various career opponents of psychiatry as well as a large number of lay-people troubled by the concept of depression as a medical illness. And as one would expect, often challenged by actual psychiatrists (but not always), focusing mostly on the inherently flawed state of measurement with regards to depression.
- zzzeek 14y ago
  Particularly troubling is the lack of critical analysis that can be found regarding Kirsch's book. Googling for it reveals tons of links from various magazines and news sites with sensationalistic headlines, feeding into an emotion that is easy to tap, which is the discomfort many people have with the entire concept of antidepressants. "Going on antidepressants? Read this first!" that kind of thing. As for a formally written challenge to Kirsch, I could only find this times editorial http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepre... which makes the argument that someone in my position has already suspected, that the studies being cited are flawed - that it is exceedingly difficult to identify bona-fide "mildly or moderately depressed" people to participate in a study, not to mention that measuring depression is a completely subjective affair: > Often subjects who don’t really have depression are included — and (no surprise) weeks down the road they are not depressed. People may exaggerate their symptoms to get free care or incentive payments offered in trials. Other, perfectly honest subjects participate when they are at their worst and then spontaneously return to their usual, lower, level of depression. Without an objective means of measuring depression, measuring the effect of drugs objectively is not straightforward. Kirsch has, like everyone else, approached this study with a definite bias, a career based on raising the prominence of the placebo affect. I'm not sure you can read a few books and declare "the truth" as case closed here, all ideas are subject to challenge. In this case I think there's a lack of interest in challenging this idea as the drug companies are obviously doing quite well (and I am no fan of drug companies) and probably don't want to raise more attention to it. It's an extraordinary claim that the millions of people who insist that SSRIs are very effective for them are being deceived en-masse, and one under-critiqued meta-study might not be enough to prove that claim. Interesting comment on that article as well: > "Papers showing that antidepressants work had found their way into print; unfavorable findings had not." The point is, that there are any number of ways a clinical trial can be run such that an "effective" drug will not be able to demonstrate a level of statistical significance. While there is no way you can run a clinical trial so that an "ineffective" drug will demonstrate a level of statistical significance. If you run nine clinical trials that fail to show a drug is active, and one clinical trial that shows that it is active; when presented with this kind of data, most people in the general public would wrongly conclude that the drug is not active. In fact, the correct conclusion is that the drug is active. That is why it is the job of qualified experts at the FDA, and not the public, to examine the information generated from clinical trials and pass judgment as to whether or not a drug has been proved to be "safe and effective". If it were possible to make an ineffective drug demonstrate a level of statistical significance, then we'd have tons of studies proving the efficacy of homeopathy, wouldn't we ?