so they 'rethought' (or actually thought) about the data... and realised that anti-d's were more likely to be harmful than helpful to children...

and then they 'rethought' (or actually thought) about the data... and realised that anti-d's were more likely to be harmful than helpful to adolescents...

anybody see where they might be going with this?

sheesh. i don't feel quite so bad supporting british american tobacco after all ;-)

[psisci]

This stuff is total politics and BS. Look at what happened with celebrex, for no reason, and may other good drug we can no longer get because people are afraid of getting sued.... It is pathetic.

> This stuff is total politics and BS.

you mean the fact that nobody checked the data properly to read off the finding that young people are harmed... and adolescents are harmed... and...

or you mean the fact that people actually did read off the finding eventually?

how about the APA knowing that SSRI's are only just more effective than placebo (where the greater effectiveness could be due to the blind being broken when people experience harmful side-effects in the active group)? and at the very same time they know this... they reccomend that people take and stay on SSRI's?

is that total politics and bs too?

[psisci]

No I mean that you are being manipulated and don't even know it. SSRIs are some of the safest drugs in clinical medicine. Propaganda does not help anyone.

the conspiracy theory is an interesting notion... do you have some evidence that i am being 'manipulated and don't even know it'? who do you think is manipulating me?

and who do you think is responsible for the propoganda, and what does the propaganda say? (i think i might have missed that).

i'm not so much concerned about the 'safety' of SSRI's as i'm concerned about their effectiveness. if the harmful side effects are due to psychological withdrawal or biological withdrawal doesn't really matter to me. stack them up on the 'harm' side of the equation either way, i say...

[drunksunflower]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
alexandra_k said:
so they 'rethought' (or actually thought) about the data... and realised that anti-d's were more likely to be harmful than helpful to children...

and then they 'rethought' (or actually thought) about the data... and realised that anti-d's were more likely to be harmful than helpful to adolescents...


</div></font></blockquote><font class="post">

How is 'harm' measured?

Increased number of suicide attempts or bad side effects?

Sorry, I am not up on the literature

[psisci]

Not conspiracy, but fear of the lawyerizing this country has turned in to. SSRI's can be very effective. If you give them to millions of people who do not have major depression, you skew the data; simple statistics. If you knew clinical medicine, psychiatry or psychology well you would know that placebo is much more powerful than many drugs, including antibiotics. Look it up and you can explain to us why. Coming here and giving people false information as though you have a grasp of the literature is not appropriate.

Yes, SSRI's do not really help borderline personality as there is really nothing much that can treat a whole personality structure.

one side effect of SSRI's seems to be an increase in suicidal ideation / urges. given that these are often precisely the reason people are prescribed the effect seems somewhat... paradoxical, shall we say?

another side effect of SSRI's seems to be all those problems people typically report while they are on the medication and also while they are trying to stop taking it. sexual problems, headaches, nausea, weight alterations, brain zaps and so on.

i'm fairly sure that the 'harm' to children was due to an increase in suicide for those taking the medication compared to those taking placebo (where both groups were indeed matched for severity).

now people are looking at the increase in suicidal urges / ideation for those adolescents taking the medication compared to those taking placebo (where both groups were indeed matched for severity).

surely the other side effects also count as likely harms that should be weighed against likely benefits for taking them.

and when calculating the benefits don't forget to calculate the differential between non-active placebo and active and also (even more importantly) non-SSRI active placebo and active. the last ensures the double blind isn't broken when people experience unpleasant side effects, you see...

the trouble comes from... firstly, the sheer amount of money that the drug companies make off medication sales. they are of course reluctant to include warnings on their product.

the drug companies put a lot of money into sponsoring research studies. if you are a researcher there is a huge difference in how much a university will pay you for your studies and how much a drug company will pay you for your studies. if you want more money (which is surely fairly rational) then you would be wise to conduct studies which (are likely to) support the efficacy of the product being marketed by the drug company.

drug companies are required to disclose information to the effect that their medication is harmful. one can of course get around this by the way one interprets the statistics. for example, one can report 'this study found that overall participants reported less symptoms of depression when taking xxx compared to non-active control' even when (at the very same time) one could also report 'this study found that in the 5-15 age group participants were twice as likely to commit suicide when taking xxx compared to non-active control'. the statistics are the same. it is the INTERPRETATION of the statistics that can be problematic. or perhaps more accurately, the fact that we do need to be selective in what conclusions we draw from a study (when there are an indefinate number of conclusions that could be drawn). people do of course draw the conclusions that they most want to / that seem most surprising.

drug companies are not required to disclose findings that show their medication to be ineffective. if a company replicates one study 50 times and finds that on 49 trials medication xxx is no more effective than placebo they will not report the findings of those 49 trials (they are not required to report the findings of those 49 trials), instead they will report that they have shown their medication to be more effective than placebo (which they have indeed shown on that one trial).

20% of scientific studies (across the board) are rejected due to people pleading 'methodological flaws' or 'contaminated samples' or some random %#@&#! up. those findings are not reported to the scientific community. what is scary is that when less than 20% of the drug company sponsored studies report that the medication is more effective than placebo this is the finding that is reported to the scientific community, the doctors, the public. when this is the situation... it makes it more likely that the studies showing medication to be effective are the mess ups and the 80% showing no effect (or fairly clearly showing harm but being interpreted as showing no effect) are the most replicable.

the stuff that is coming out now... isn't due to any new trials that have been conducted. it is due to people doing a literature review of the studies that have been conducted thus far (studies sponsored by drug companies in fact) and basically... reinterpreting the stats. how is it that we never interpreted the stats this way in the first place?

there are none so blind as those who do not want to see...

and of course even if the medication is 40% effective and placebo is 100% effective it is considered UNETHICAL TO PRESCRIBE A MEDICATION THAT IS IN FACT A PLACEBO / INERT. now... is that due to good medical practice or due to politics / profits do you think? you can't patent a placebo... can you?

[psisci]

Sounds like the anti-psychiatry stuff I can get if I google "psych meds, borderline". There are so many flaws in your logic, and I do not have time to address them. I just have to say that as a psychologist, and one who has done a medical psych residency with 10 years of additional medical and pharmacology training, that you are misleading people based upon pseudoscience.

> Not conspiracy, but fear of the lawyerizing this country has turned in to.

i should clarify that i'm not from the US. i accept your gripe here, but think this is a somewhat seperate gripe...

> SSRI's can be very effective.

more accurate than placebo when the double blind isn't broken by side effects?????

then don't forget to add the harm to the equation (side effects, increase in suicidal ideation / urges / behaviour)...

> If you give them to millions of people who do not have major depression, you skew the data; simple statistics.

i agree that depression is indeed overdiagnosed considerably. that being said... who is doing the overdiagnosing, would you say?

don't you think that the people who they select for the studies are people who are infact fairly reliably regarded to be clinically depressed? do you have an issue with how the drug companies select their patient sample?

> Coming here and giving people false information as though you have a grasp of the literature is not appropriate.

please point out to me where i've provided false information. please don't jump to conclusions about my understanding of the literature, either. if you have a problem with my claims then tell me why and we can discuss it. thanks.

[drunksunflower]

Isn't it interesting how statisticians can often make the data say pretty much anything they want it to?

I am sooo out of the loop since I stopped studying ... I am sure psisci can correct me.

But I thought with the use of ADs in adolescents there has for quite some time been guidelines in place that the clinical need should be balanced with the risk of increase of suicidal ideation etc.

E.g., it's prescribed quite carefully and often to a group of patients who are at elevated risk anyway?

Much the same principal as if you're prescribing ADs for a pregnant woman and the risks and benefits there?

Just curious ... please feel free to correct me :>

[drunksunflower]

Btw I do not proclaim to be expert, but what psisci says also makes a whole lot of sense, alex ...

> Sounds like the anti-psychiatry stuff...

well you can call me 'anti-psychiatry' and i can call you a 'drug company propagandist' and that doesn't really advance the situation at all. instead of calling each other names how about we actually discuss things?

> There are so many flaws in your logic, and I do not have time to address them.

if you don't want to participate in this thread then please leave it to people who do have the time. please don't call me names / make unsubstantiated claims about me. if you don't have the time to provide concrete examples of where i'm going wrong please have some faith that other people might be in a better place to do that. of course... it might well turn out... that i have a point.

> I just have to say that as a psychologist, and one who has done a medical psych residency with 10 years of additional medical and pharmacology training, that you are misleading people based upon pseudoscience.

and i'll say that your appeal to authority and name calling wouldn't convince someone who had done half a semester of critical reasoning.

> what psisci says also makes a whole lot of sense, alex ...

which claims do you have in mind?

thanks.

[drunksunflower]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
alexandra_k said:
> what psisci says also makes a whole lot of sense, alex ...

which claims do you have in mind?

thanks.

</div></font></blockquote><font class="post">

In light of how SSRIs are often used. Read the 'skew the data' posts.

Previous posts by Dr. Wylie have outlined that they do not work for everyone and reasons why ... I am sure he can elaborate if you so wish to have those posts repeated

I am sure you have some good points but I suppose neither you nor I work in primary care and see the efficacy of these meds in a lot of patients - do we?

> In light of how SSRIs are often used. Read the 'skew the data' posts.

i'm not sure how that affects my point here. i'm not talking about the efficacy of SSRI's in every single person they are prescribed to (where GP's for example are often guilty of over-diagnosing). i'm talking about the efficacy of SSRI's in research studies where i'd assume they would be very careful indeed to pick out people who are in fact severely clinically depressed.

> I suppose neither you nor I work in primary care and see the efficacy of these meds in a lot of patients - do we?

i'm not sure how that relates either. clinical observations are unable to seperate the effect of the medication from the effect of placebo. that is the whole point in having double blind randomised controlled trials...

[drunksunflower]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
alexandra_k said:

> I suppose neither you nor I work in primary care and see the efficacy of these meds in a lot of patients - do we?

i'm not sure how that relates either. clinical observations are unable to seperate the effect of the medication from the effect of placebo. that is the whole point in having double blind randomised controlled trials...

</div></font></blockquote><font class="post">

I am simply pointing out how easy it is to come from an academic ivory tower perspective here

[drunksunflower]

And also how I'm sure someone who is so involved with treatment on a practical level would have a pretty solid critical perspective on the research you are citing.

The words 'expert vs amateur' seem to spring to mind ...

You may take that as a criticism but I would hold the expectation that someone like Dr. Wylie would have a fairly good reason to call something BS, and wouldn't be throwing that opinion around lightly.

Just my own view, however...

> And also how I'm sure someone who is so involved with treatment on a practical level would have a pretty solid critical perspective on the research you are citing.

A lot of people blame doctors for getting things wrong (in the sense of prescribing ineffective or positively harmful medications). That doesn't seem fair to me, however. The doctors get their information from the drug companies (and they are indeed smart enough to appreciate that that is 'advertising' rather than 'information'). The problem comes with medication trials being reported in the literature, however. Practicing doctors simply don't have the time to read every study that has been conducted and to grasp the statistical manipulation of the data in order to draw their own reasoned conclusions. Instead, they trust that conclusions drawn from peer reviewed leading journals are accurate and they base their prescription decisions on that. I mean really, what else are they supposed to do?

> The words 'expert vs amateur' seem to spring to mind ...

Please don't jump to conclusions about me. You have no idea who I am and what training I may or may not have had. If you are unable to discuss as opposed to namecall then please leave this thread for people who are able to discuss.

> I would hold the expectation that someone like Dr. Wylie would have a fairly good reason to call something BS, and wouldn't be throwing that opinion around lightly.

The difference is that I'm questioning the information that Dr. Wylie is supposed to be basing his medical decisions on. He has already granted that the APA knows full well that SSRI's are barely more effective than placebo and yet Dr Wylie posted their reccomendation (that he seemed to be endorsing) that people take and stay on their anti-depressant medication.

The issue is: Reinterpretation of the studies (studies funded by the drug companies no less) seems to be resulting in their reconcluding that SSRI's are likely to be more harmful than helpful to:

- children
- adolescents

and i'm saying 'what next'.

aka: lets look again at the data on adults.

[drunksunflower]

>Instead, they trust that conclusions drawn from peer reviewed leading journals are accurate and they base their prescription decisions on that.

I am sure they do. However, I'd be surprised if that's the *only* source of their decisions, wouldn't you? No matter what you say about clinical practice not being 'objective' (which is the gist of what I gathered you were commenting on earlier), I'd imagine that there is plenty of communication between professionals on what's working vs not working in practice. Statistics, especially ones that are being reworked over again, are not the be all and end all factor in prescribing decisions, as far as I know.

> Please don't jump to conclusions about me. You have no idea who I am and what training I may or may not have had. If you are unable to discuss as opposed to namecall then please leave this thread for people who are able to discuss.

I am not jumping to any conclusions. I have read your posts over quite some time now, and while I'm sure you are a bright girl, I always get the sense that you're coming from a very academic POV and that you are well versed in the abstracts from several psychology databases. I have spent enough time in the university system to know what a post-graduate's writing style looks like. When I was in that position I know I pulled out all my research-oriented knowledge in many situations to prove my point too Towards the end of my thesis I must say I got rather jaded with the amount of bad research that's out there in psychology ...

By the way, if you are kicking both psisci and myself out of the thread ... well, I guess you win the argument then?

> The difference is that I'm questioning the information that Dr. Wylie is supposed to be basing his medical decisions on.

Hmmm ... that's an interesting thing to say about the intelligence / integrity of someone with his amount of training, but I suppose you are entitled to your opinion

> I'd be surprised if that's the *only* source of their decisions, wouldn't you?

I'd say that advertising goes a long way. Doctors aren't all *that* much more immune to the effects of advertising than the rest of us. Drug company representatives often present their findings during grand rounds.

> No matter what you say about clinical practice not being 'objective' (which is the gist of what I gathered you were commenting on earlier), I'd imagine that there is plenty of communication between professionals on what's working vs not working in practice.

I didn't say it wasn't objective I said (and I'll say it again) that clinical practice is unable to tell you whether the response to treatment is greater than the response to placebo. Once again, that is precisely the point of running double blind randomised control trials.

Double blind randomised control trials are often hailed as the best scientific methodology that we have for sorting this out. Advertising isn't going to help. Clinical observations aren't going to help (since one isn't allowed to conduct ones own double blind randomised control trial to see whether patient response is greater to medication than either inert or active placebo).

> Towards the end of my thesis I must say I got rather jaded with the amount of bad research that's out there in psychology ...

Right. That is the whole point in doing a little critical reading / thinking about the research that has been done.

> if you are kicking both psisci and myself out of the thread ... well, I guess you win the argument then?

It isn't about winning. It is about having a discussion. An actual discussion where people don't discount what I've said (and discourage others to discount what I've said) by name calling: e.g., 'amateur', 'anti-psychiatrist' and so on.

>> The difference is that I'm questioning the information that Dr. Wylie is supposed to be basing his medical decisions on.

> Hmmm ... that's an interesting thing to say about the intelligence / integrity of someone with his amount of training, but I suppose you are entitled to your opinion

Please don't accuse me (or jump to conclusions about my) questioning the intelligence / integrity of Dr. Wylie. It is precisely these kind of assumptions that lead people to believe that patients are unable to have intelligent rational discussions without resorting to propaganda techniques of name calling, making appeals to authority, and using 'buzz words' like 'anti-psychiatry' in order to undermine someone by association.

It is a fact that the majority of doctors do not have the time to read every study that has been conducted on every condition that their clients are likely to present with. A doctor who engaged with the literature wouldn't be a practitioner they would be a researcher. Practicing doctors rely (when all goes well) on the peer reviewed literature in their field in order to make the most empirically adequate treatment decisions. Practicing doctors rely (when all does not go well) on the claims of the drug company representatives during grand rounds or during the drug company funded presentations or luncheons at conferences.

When the peer reviewed scientific literature amounts to little more than drug company advertisements sponsored by drug companies then the science is being polluted.

My beef isn't with the practitioners who (wisely) base their treatment decisions on the literature) - I mean really, that is the most empirically adequate thing they could be expected to do. My beef is with the researchers (those whose job it is to interpret research findings) taking one hell of a long time to find out about the harm to children and adolescents. Whatever next... That is my point.

Have recent events led the APA to rethink their reccomendation about medication for depression? Seems not. Anybody wonder why???

[drunksunflower]

Okay, you make some valid points, I'll give you that.

a) I don't know enough about how doctors make their decisions, but I am assuming many other variables such as funding, insurance, etc also come into treatment decisions. Possibly to a greater degree than advertising ... one would hope, anyway :>

b) In response to your second point, while methodologically you are correct re double blind, I suppose I was more meaning that surely decisions are made more on a triangulation base ... qual and quant research studies, observation ... etc

c) I gathered psisci was also critiquing the research ...

d) Just calling it how I see it ... I am making the assumption that what you do is primarily academic. Apologies if I am incorrect.

e) But it seems you are questioning his judgement. You essentially say he's making his decisions based on potentially incorrect information. I would just have thought that someone so well versed in psychopharmacology would have also considered the issues you are raising in this thread, and be basing his drug decisions on his own conclusions.

But far be it from me to assume ...

> while methodologically you are correct re double blind, I suppose I was more meaning that surely decisions are made more on a triangulation base ... qual and quant research studies, observation ... etc

yeah. randomised double blind control trials are often hailed as the (current) epitome of 'evidence based medicine'. 'evidence based medicine' has become something of a catchphrase, however. if you are against evidence based medicine does that mean you think medicine should be based on... divine command? evidence based medicine / randomised double blind control trials are often downplayed in psychology because it is hard to deliver psychotherapy (for example) under those conditions. what methodology is the best does indeed depend on what it is that you want to know. with respect to measuring the efficacy / effects of medication, the methodology is pretty good, however (when adhered to).

> c) I gathered psisci was also critiquing the research ...

yeah. i'd like to have a good discussion with psisci :-)

> ...You essentially say he's making his decisions based on potentially incorrect information. I would just have thought that someone so well versed in psychopharmacology would have also considered the issues you are raising in this thread, and be basing his drug decisions on his own conclusions.

ah... i see what you mean here.

i was questioning the scientific studies, yup. i guess i'm not suggesting that the studies are 'incorrect' so much as not generalisable the way they have been taken to be. that the findings might be generalisable in ways that were originally unforseen (e.g., with respect to children and adolescents).

it comes down to time constraints. if one is spending a lot of ones time seeing / prescribing for patients then there are only so many hours in the day left for researching and drawing ones own conclusions. one simply can't do everything. if i were to see a doctor... i'd be happy and impressed if they were basing their treatment decisions from the latest research in the leading journals. very happy indeed. i most certainly wouldn't expect them to be thoroughly reading them and thinking critically about them, however. that is a job for the researchers. that is supposed to be the point of the peer review process.

like i said i'm NOT saying that the doctors should have found this out about the SSRI's. the scientific community, the researchers, those involved in the peer review process, those are the people who jolly well should have seen this well before now.

what is a doctor supposed to do??????

this most certainly is NOT anything personal about psipsy.

this is mostly about the APA treatment reccomendations for depression and in particular what they are going to do about them now.

it is also about... informed consumers.

when the APA reccomends (and when psychiatrists 'heavily encourage') people to take medication... in spite of side effects that people report... against their will in some instances... you have to wonder how much this is about political agenda. in particular... who will sponser their journal / fund their conference / buy their luncheon / provide their stationary / justify their being a branch of medicine...

[drunksunflower]

Hmmm ...

As you might have gathered I'm a qual researcher anyway, and I have (as it was recently described to me by a former lecturer, tutor, and boss of mine hehe) 'gone to the dark side' in terms of what I do nowadays.

So I am a little out of practice with reading and critiquing some of these things, although I am well familiar with the methodologies etc. Had a lot of drug and alcohol studies to review during thesis

But ... my area is not psychopharmacology really (in terms of efficacy of treatments), so I am probably playing a little bit more devil's advocate than anything else in this thread :>

I know that drug companies often have their own agendas but then I see a lot of GOOD coming out of them too ... the Pharmac heart campaign here in NZ that's absolutely brilliant and about getting medication to those who really really need it ... so maybe Pharmac is a big greedy monster in some ways, but you have to look at the positives to come out too.

I suppose that is why I am not automatically buying in to the idea of advertising etc being all evil ... (no it's not just cos I'm in marketing ... lol).

Sigh. I wish I was less tired and better able to explain myself - lol.

[psisci]

First of all, of course drug companies have their own agenda! They are in the business to sell their drugs and to make $; it is naive to think differently, and even more so to expect them to somehow be altruistic when the rest of the business world is not.

alexandar_k your understanding of the thought process that goes into prescribing meds is way off base and shows little understanding of the medical model, clinical medicine in general, and how people come to choose one med over another med or over another therapy. I have to say that I have never met a doctor who prescribes meds by reading a journal article, or even a set of articles and then says, "okay they said it works so I am giving you this, take it regardless of side-effects and regardless of whether you want to or not". Decision making for meds is a multilayered experience. The most important aspect is prior experience with a certain med, then comes the myriad of medical issues, genetic issues, and psycho-social issues that need to be considered, and lastly is research base.
Why would I give Remeron to one patient and Effexor to another? Both work on serotonin and NE in a predictable way? Any thoughts? I can guarantee the answer, and the answer for every other doc has nothing to do with double-blind studies, drug company advertising, free pens or meals or any of the things you mentioned.