3 ms·

Your tl;dr for #2 isn't accurate. Yes, these medications "have reported only modest benefits over placebo treatment", but the measured benefit of placebo treatm

• lutusp 12y ago
  > Your tl;dr for #2 isn't accurate. Yes, these medications "have reported only modest benefits over placebo treatment", but the measured benefit of placebo treatment in this case is quite large and the medications work BETTER than placebo. Yes, unless unpublished studies are included in the analysis, after which the effect falls below that required to make a claim of clinical effectiveness. That distinction is perfectly clear in the post to which you replied. > As for the claim that the difference falls below accepted criteria for clinical significance, the "accepted criteria" used to reach that conclusion are pretty arbitrary and it only just BARELY falls below the arbitrary level picked (by some), depending on which studies are included. Weasel words, words that a scientist wouldn't dream of including in a study means to generate light, not heat. Which explains why this kind of argument is absent from the FDA study. In any case, a more recent study quoted above finds no correlation between serotonin and depression. If this study bears up under scrutiny, it undermines the basis for SSRIs as a remedy for depression, for the simple reason that serotonin and depression have no relationship. It would explain why the statistics for SSRIs are so marginal -- what's being measured is a placebo response.
  • glenra 12y ago
    > Yes, unless unpublished studies are included in the analysis, after which the effect falls below that required to make a claim of clinical effectiveness. That distinction is perfectly clear in the post to which you replied. I think you are not reading carefully. Even WITH the unpublished studies included, the placebo effect far exceeds the required effect size to be considered clinically effective which means that the combination (placebo effect+treatment effect) also far exceeds the required effect size. And the claims you make are pretty clearly rebutted in the first link I provided, which gives precise numbers to the different "clinical effectiveness" strengths. (Regarding the correlation between serotonin and depression, if it bears up it will likely establish that there is some OTHER reason that Paxil is a moderately effective antidepressant.) Here's a relevant quote from that link I gave before: ( http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... ) "They also note that Kirsch’s study lumps all antidepressants together. This isn’t necessarily wrong. But it isn’t necessarily right, either. For example, his study used both Serzone (believed to be a weak antidepressant, rarely used) and Paxil (believed to be a stronger antidepressant, commonly used). And in fact, by his study, Paxil showed an effect size of 0.47, compared to Serzone’s 0.21. But since the difference was not statistically significant, he averaged them together and said that “antidepressants are ineffective”. In fact, his study showed that Paxil was effective, but when you average it together with a very ineffective drug, the effect disappears. He can get away with this because of the arcana of statistical significance, but by the same arcana I can get away with not doing that. So right now we have three different effect sizes. 1.2 for placebo + drug, 0.5 for drug alone if we’re being statistically merciful, 0.3 for drug alone if we’re being harsh and letting the harshest critic of antidepressants pull out all his statistical tricks."
    • lutusp 12y ago
      > Even WITH the unpublished studies included, the placebo effect far exceeds the required effect size to be considered clinically effective which means that the combination (placebo effect+treatment effect) also far exceeds the required effect size. This is astonishing. The paper in question flatly contradicts you. The paper concludes, "antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance." The above conclusion is not open to the interpretation you've given it. And, in case you missed the train leaving the station, none of this will matter until some science is done -- science that uncovers the cause of depression and ends this guessing game and debating society.