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bekilledoff t1_ivpaikv wrote

the value in studies like this is establishing empirical data for the clinical efficacy for the newer treatment. the antidepressants were already proven to be effective, and mindfulness as a treatment modality is relatively new in Western mental health care.

some people are allergic to certain drugs. some people need medication and can't practice mindfulness skills.

it's good that both treatment options are effective


[deleted] t1_ivpanor wrote



continentalgrip t1_ivpeojz wrote

"Thus, we had data on unpublished trials as well as published trials. This turned out to be very important. Almost half of the clinical trials sponsored by the drug companies have not been published (Melander, Ahlqvist-Rastad, Meijer, & Beermann, 2003; Turner, Matthews, Linardatos, Tell, & Rosenthal, 2008). The results of the unpublished trials were known only to the drug companies and the FDA, and most of them failed to find a significant benefit of drug over placebo. A second advantage of the FDA trials in the FDA dataset is that they all used the same primary measure of depression – the Hamilton depression scale (HAM-D). That made it easy to understand the clinical significance of the drug-placebo differences. Finally, the data in the FDA files were the basis upon which the medications were approved. In that sense they have a privileged status. If there is anything wrong with those trials, the medications should not have been approved in the first place.

In the data sent to us by the FDA, only 43% of the trials showed a statistically significant benefit of drug over placebo. The remaining 57% were failed or negative trials. Similar results have been reported in other meta-analyses (Turner et al., 2008), including one conducted by the FDA on the clinical trials of all antidepressants that it had approved between 1983 and 2008 (Khin, Chen, Yang, Yang, & Laughren, 2011). The results of our analysis indicated that the placebo response was 82% of the response to these antidepressants. Subsequently, my colleagues and I replicated our meta-analysis on a larger number of trials that had been submitted to the FDA (Kirsch et al., 2008). With this expanded data set, we found once again that 82% of the drug response was duplicated by placebo.

More important, in both analyses, the mean difference between drug and placebo was less than two points on the HAM-D. The HAM-D is a 17-item scale on which people can score from 0 to 53 points, depending on how depressed they are. A six-point difference can be obtained just by changes in sleep patterns, with no change in any other symptom of depression. So the 1.8 difference that we found between drug and placebo was very small indeed – small enough to be clinically insignificant.


neuro__atypical t1_ivpil5o wrote

SSRIs are "effective," in the clinical statistical use of the term. But the effect size and success rate is very small compared to other drugs. They're pretty crappy.


neuro__atypical t1_ivpt4j7 wrote

SSRIs' slight advantage over placebo could also be explained by their downstream effects on BDNF. Not everyone is responsive to BDNF/neurogenesis as a treatment for depression though, and the effects on BDNF are extremely weak compared to other neurogenesis-promoting drugs.


continentalgrip t1_ivpubg5 wrote

The link it kind of looks like you didn't read? indicates they are not clinically effective.


neuro__atypical t1_ivpy51l wrote

Sorry, I seem to have mixed up clinical and statistical significance. I was trying to respond to this part of your link:

> Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind.

Saying that it could be better explained by SSRIs' small but very real effect on BDNF (agents which promote BDNF to a much higher degree show actual clinically significant improvements in rats, e.g. Semax) than a hypothetical "enhanced placebo effect."


continentalgrip t1_ivq6vgm wrote

I have worked last ten years as a clinical trials study coordinator. Some patients start taking study drug and immediately have obvious side effects making it trivially obvious they're not on placebo. So I definitely believe in enhanced placebo. Additionally I have given the HAMD to many patients over extended periods and have seen scores go up and down ten points easily. 1.8 points is really not much.