Comments on Mature Landscaping: And The Award For Perfect Timing Goes To...

Good article. My two cents: I think many people a...

2010-04-03T11:02:39.444-04:00

Good article.
My two cents:
I think many people are under the mistaken impression that medications either work or don't. Is penicillin a 100% effective treatment for pneumonia? I doubt it. Very, very few treatments even approach 90% efficacy.
Pain medications, allergy medications, etc . . . some forms of these can be as low as 20% effective. Which doesn't mean they are worthless. It means that most people needing help might want to try them, but keep in mind they are likely to be one of the those not helped. Should 20% effective medications be prescribed? If the placebo response is a mere 5%, that 15% difference could end up helping many, many people if we don't expect it help everyone. Hypothetically, 15 people out of 100 will be glad to have found such an "ineffective" medication.
Even a "scant" 5% difference between placebo and treatment can be significant and should not be poo-pooed.

Sorry for the slow response. You are brilliant...a...

2010-02-15T14:11:53.126-05:00

Sorry for the slow response. You are brilliant...as usual. My only experience with an anti-depressant was Zoloft in 2001. I did not eat for a whole month. I lived solely on pepsi...and was completely unaware until my roommate corner me with a king size snickers because she though I was turning anorexic. So I quit the pills that day. I wasn't sad or depressed in the first place...but being a zombie didn't do me much good.

Thanks so much for commenting on Ronni's blog....

2010-02-14T11:50:53.033-05:00

Thanks so much for commenting on Ronni's blog. This was helpful!
- Mary Jamison

I am not ashamed to say that I take an antidepress...

2010-02-06T19:28:11.924-05:00

I am not ashamed to say that I take an antidepressant for anxiety and it has made me a better person. When I first started taking it it was for crying and anger at any little thing. (start of PMS) I am a much happier person when I take the little pill and people around me are happier people also.

I'm afraid that print information is becoming ...

2010-02-06T17:10:04.115-05:00

I'm afraid that print information is becoming as junky as the web.

If information is presented for the purpose of increasing links or sales, it hardly matters, we're all struggling in one big tabloid. So to speak.

AARP Magazine, which has its own agenda, is a good...

2010-02-06T14:00:57.915-05:00

AARP Magazine, which has its own agenda, is a good example of a media using statistics (numbers, percentages, etc.) to persuade or impress its readers. Try flip-flopping some of the percentages and consider what THAT means. But it can be tricky; example: stating that 65% of people in a study reported that they love chocolate doesn't mean that 35% hate chocolate; maybe 10% hate it and 25% do not have a preference. Here’s one from AARP: “Buy oatmeal in those cardboard cylinders [instead] and you’ll trim up to 75% from the cost of breakfast” Breakfast? Shouldn’t that be off the cost of single serving packets which they referred to?

This is scarier than the attack on ADHD and it'...

2010-02-06T12:05:14.811-05:00

This is scarier than the attack on ADHD and it's medications. Just when you convince yourself and those around you that you're doing the right thing being on medication, there's some news article that stirs up doubt. No doubt in my mind though; antidepressants work here.

I, too, read this article with a keen interest as ...

2010-02-06T12:04:09.406-05:00

I, too, read this article with a keen interest as soon I received the issue. So I was glad to read your timely review. I was particularly intrigued with the following discussion by Kirsch. Per the article: “Patient volunteers are told they will receive either the drug or a placebo, and that neither they nor the scientists will know who is getting what. Most volunteers hope they get the drug, not the dummy pill. After taking the unknown meds for a while, some volunteers experience side effects. Bingo: a clue they’re on the real drug. About 80% guess right, and studies show that the worse side effects a patient experiences, the more effective the drug. Patients apparently think, this drug is so strong it’s making me a vomit and hate sex, so it must be strong enough to lift my depression. In clinical-trial patients who figure out they’re receiving the drug and not the inert pill, expectations soar.”

This would seem to have a profound effect and conclusions on these studies. Consider other disease studies. In consideration of your question: “If the placebo effect can color patient response to antidepressants, can researcher bias color the interpretation of statistics?” A researcher can manipulate the interpretation but then the science of statistics is defeated and that would be brought to light. But it is what is presented by the user of statistical data we should be weary of. We are subject daily to everyone’s interpretation – the feds, the media, the marketers, and the greedy. It’s easy to report that, as an example, 40% of the voters were against XXX – thus promoting the writer’s interest possibly. That means that 60% voted FOR XXX.

I interpreted Kirsch’s comment, “By and large, the unpublished studies were those that failed to show a significant benefit from taking the actual drug” as acknowledgement that in fact, statistically, these unpublished studies are significant for that very reason. He was later encouraged by Thomas Moore, GWU, to include these unpublished studies in to his own, and as you pointed the margin of difference was reduced. From the article: “About 82% (18%)of the response to antidepressants – not the 75 % (25%) he had calculated from examining only published studies - had also been achieved by a dummy pill”.

Who, really, is responsible for the possibility or impression that they were hidden or kept secret? The coalition? Timing may be unfortunate as you point out; it reminds me of the results of the studies about having mammograms last fall and the study about Hormone Replacement Therapy in 2007; but people in need of help have always been here. I agree with you too that blind trust is a bad idea so this may be an “educational moment”. Skepticism is useful; what if some of those patients had countered their expectations with some; the statistics might have been very different.

Dear Readers, Your thoughtful comments matter! Ea...

2010-02-06T08:36:58.850-05:00

Dear Readers,

Your thoughtful comments matter! Each blog post, each comment, represent small acts of courage; whether we seek to abuse, inform, encourage, or create change, we build something together. Besides, I think you're fabulous!

Ann,

Your question is excellent! The tool used in most depression studies (and in all of the ones cited here, I believe) is the Hamilton Rating Scale of Depression, developed in 1960. It's short, multiple choice, and entirely self-rated. Similar to the ten-point subjective pain assessment scale, its use lies in its simplicity and its been almost universally accepted for research for decades.

A more objective means...that's The Holy Grail of mental health research. PET scans and fMRI's let researchers look at the actual brain for markers of depression, but they are not widely available and their interpretation is not standardized yet. When that kind of information becomes widely available, watch for it to change everything from diagnosis, to treatment, to the way we all think about "mental" health.

Yes, it is disturbing that this opinion is on the ...

2010-02-05T22:48:57.448-05:00

Yes, it is disturbing that this opinion is on the cover of such a respected rag. Personally, I am a believer and that is after multiple attempts without medication. It helps hold me together, along with everything else I can do. I am no expert but I am a little puzzled that the statistics are based on people's subjective comments. Isn't there objective data to back up the positive results produced from antidepressants? When I first started on an antidepressant, I was not aware of the difference, but my friends said it was notible. Then, as I stated earlier, I became a believer after trying to live without the use of an antidepressant. This article could negatively affect a number of people and sell a lot of books. Something is very wrong about that.
Ann

Hi Nance Great post. I left you a long comment on...

2010-02-05T21:35:51.517-05:00

Hi Nance
Great post. I left you a long comment on your last post. It either wasn't relevant and went bye-bye or it never made it thru. Either way, have a great weekend!

I have two stories about anti-depressants, but fir...

2010-02-05T21:26:44.704-05:00

I have two stories about anti-depressants, but first... Judging from the number of diet ads on the t.v. that make wild claims, and which are also "FDA approved" I tend to follow the school of thought that the FDA will approve some things based on the fact that it will neither kill nor (seriously) harm you. Most medication designed to bring us back into balance (either physically as in the case of weight loss, or mentally as with anti-depressants) should work better with a good diet and exercise. That just makes sense.

That being said, I used to work with a lady at the Wal-Mart that was on anti-depressants. She called them her "I don't give a ____ Pills." (Fill in the blanks yourselves... this is a family post) She stopped taking them. Not because they didn't work, but because they worked too well. She said she'd rather feel this incredible burden than to feel nothing at all.

My other story is about my somebody very close to me. She carried the burden of depression for some time, and boy did it weigh on us. She wasn't really capable of doing anything because of it... It's really hard to describe living with a person with chronic depression. That weight "seeps" out into every aspect of their lives. "Fixing" it with lifestyle changes is an uphill battle that is made more difficult by being bogged down in a mire of self doubt, loathing, and... well... depression.

The decision to try anti-depressant medication was a big one. Getting rid of the depression was a definite plus... but to do that at the potential cost of her core personality (eg "I don't give a ___ Pills)just didn't seem worth it. To make an already too long story short(er), she started them, and is much the better for it. We actually have her back.

As for this article convincing people to stop taking them? Who knows? I'd like to think that the "stupid/ignorant" Americans of stereotype are in the minority, and just get more airplay because they're louder than everybody else. So hopefully people reading this will see it for what it is (a cry for help from a medium that is struggling to find its way in a new world) and also know themselves well enough to move forward on their own paths.

Do they work? Sometimes. Do they work better tha...

2010-02-05T18:31:06.499-05:00

Do they work? Sometimes. Do they work better than other things such as intensive exercise, psychotherapy, ditching the problem--sometimes and for some people. But I agree with Ashleigh's comment--they have helped me and people I know, whether as a placebo effect or through actual science. My fear is that this will only make it easier for people who are themselves free from depression and inclined to think those affected with it are whiners to make a (facile and uninformed) case for their point of view.

I lived for 50 years with a knot in my stomach. T...

2010-02-05T16:14:47.853-05:00

I lived for 50 years with a knot in my stomach. Thought everybody had one. Around menopause, my gyn suggested generic zoloft. I worried, I sighed, I researched and I filled the 'script. The knot's been gone, I'm less angry with the world, and I don't care if it's a placebo or chemical - IT WORKS!

Newsweek is holding on with both hands, it seems, to the 16 or 17 people who still read news magazines. How about the Let's Kill Granny headline last summer????