Comments on: If You’ve Seen One Antidepressant…. http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/ News, Comment and Conversation Sat, 20 Mar 2010 22:42:23 +0000 http://wordpress.org/?v=2.6.2 By: MedsVsTherapy http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-414206 MedsVsTherapy Mon, 27 Jul 2009 03:36:32 +0000 http://www.pharmalot.com/?p=17750#comment-414206 Scott comments: "4. Research done by the pharma companies is inherently bad." No, it is inherently biased. In science, if bias is at all plausible, it is a threat to validity prima facia. This study, and a range of studies with such dishonesty, merely make this point. Scott comments: "I have had patients report serious violations of legal and moral/ethical conduct of more than thirty therapists." This is a totally different issue. Also, when ppl learn that I do health care resaerch for a living, I begin to hear the same horror stories about terrible things done by physicians. Neither meds nor therapy wins this one. Any person being mistreated by a counselor or therapist needs to prosecute to the full extent of the law. Period. then, go after their license. Scott comments: "It is hard to evaluate your community’s therapists in any objective way." Scott: please tell me the system you have in place for determining decent counselors / therapists in your vicinity. The answer for nearly all physicians, including psychiatrists, is that they do nothing to systematically inform themselves regarding decent local counselors / therapists. There are a handful of studies out there documenting this. For brevity's sake, I won't list them. ALSO: this issue is worthwhile. And so, instead of NIMH funding yet another drug study for yet another me-too drug, THIS issue: how to get psychiatrists, and other docs, to link patients up with good counselors / therapists - is an issue that needs research. AHRQ addresses these types of issues. NIMH could, too. You know what the drug companies are doing: making time-release as their patent expires. Making patch, nasal, etc. delivery as patent expires. Exploring similar molecules as patent expires. See a pattern? Scott says: "It is very hard to research the effectiveness of therapy." No, it is not. There is an extensive body of evidence for psychotherapy going back decades. Efficacy. Mechanisms. Etc. I have participated as a resaercher and clinical provider in several of these. I have also been part of a team developing a drug therapy intervention. Studying talk therapy is not "very hard." And, I can declare first-hand, it is easier than studying pill interventions. Scott comments: “4. Research done by the pharma companies is inherently bad.” No, it is inherently biased. In science, if bias is at all plausible, it is a threat to validity prima facia. This study, and a range of studies with such dishonesty, merely make this point.

Scott comments: “I have had patients report serious violations of legal and moral/ethical conduct of more than thirty therapists.” This is a totally different issue. Also, when ppl learn that I do health care resaerch for a living, I begin to hear the same horror stories about terrible things done by physicians. Neither meds nor therapy wins this one. Any person being mistreated by a counselor or therapist needs to prosecute to the full extent of the law. Period. then, go after their license.

Scott comments: “It is hard to evaluate your community’s therapists in any objective way.” Scott: please tell me the system you have in place for determining decent counselors / therapists in your vicinity. The answer for nearly all physicians, including psychiatrists, is that they do nothing to systematically inform themselves regarding decent local counselors / therapists. There are a handful of studies out there documenting this. For brevity’s sake, I won’t list them. ALSO: this issue is worthwhile. And so, instead of NIMH funding yet another drug study for yet another me-too drug, THIS issue: how to get psychiatrists, and other docs, to link patients up with good counselors / therapists - is an issue that needs research. AHRQ addresses these types of issues. NIMH could, too. You know what the drug companies are doing: making time-release as their patent expires. Making patch, nasal, etc. delivery as patent expires. Exploring similar molecules as patent expires. See a pattern?

Scott says: “It is very hard to research the effectiveness of therapy.” No, it is not. There is an extensive body of evidence for psychotherapy going back decades. Efficacy. Mechanisms. Etc. I have participated as a resaercher and clinical provider in several of these. I have also been part of a team developing a drug therapy intervention. Studying talk therapy is not “very hard.” And, I can declare first-hand, it is easier than studying pill interventions.

]]> By: Scott http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-382708 Scott Mon, 24 Nov 2008 05:14:58 +0000 http://www.pharmalot.com/?p=17750#comment-382708 The theories that appear to be represented in the previous comments are that: 1. Therapy is good. 2. Pills are bad. 3. There is no difference in how bad the pills are. 4. Research done by the pharma companies is inherently bad. Let’s review one at a time: 1. I have had patients report serious violations of legal and moral/ethical conduct of more than thirty therapists, ranging from sexual abuse to encouraging "cult" membership. In the few cases where the individual is well enough and has the necessary courage to do so, reporting of the behaviors have led to slaps on the wrists up to criminal prosecution. At least the pills come with some warning labels. It is very hard to research the effectiveness of therapy, but I encourage anyone with significant mental illness, loss of coping effectiveness or on psychoactive medication to undergo therapy. The pills are cheap compared to therapy and many people are uncomfortable talking about their problems. The good prescriber is knowledgeable of the cost and availability of therapy as well as medicines and seeks efficacy from both. It is hard to evaluate your community's therapists in any objective way. 2. Medication helps some people, does not help others and has the potential for harm if not judiciously prescribed. The same holds for therapy. Some therapists are good, some are not, and some may harm a person if they are not careful. I encourage every patient to permit their therapist to consult with me and me to consult with the therapist. I will not support a therapeutic relationship without checks and balances. This policy also extends to every medical specialist I refer a patient to. I can’t safely work with a patient who gives me selected excerpts from their healthcare story. 3. Pills are not all the same. Therapy for any disorder must be customized to the patient. The serotonin, norepinepherine and dopamine drugs and their combinations have various shades of effectiveness. It is a great pleasure to me and colleagues to see a chronically disabled patient become functional, even happy, when pharmaceuticals work and extremes of behavior (especially if they have caused incarceration or commitment) are controlled. I am equally happy if that result comes about from non-pharmaceutical treatment. 4. Research funding by pharma is a two edged sword. We will get better results when we start applying criminal sanctions to those who withhold data or impeded to public’s right to know. In the interim, at least we know about pharma. They are capitalist companies doing what earns their share holders the best return available for their investments. The replacement will either be taxpayer support or a direct relationship between America’s research universities and pharma. If you think the military industrial complex is scary, academia and pharma will definitely keep you up at night. When the publish or perish crowd takes over we will suffer under the weight of poor quality research timed to run on grant cycles. We will all long for the days when pharma hired the output of our universities to do their research and there was at least the appearance of an arms length of separation. Finally, the bottom line: We want the best healthcare at Wal-Mart prices. Someone has to pay the piper if this nation if to remain a leader in biomedical research and quality of medical care. The theories that appear to be represented in the previous comments are that:
1. Therapy is good.
2. Pills are bad.
3. There is no difference in how bad the pills are.
4. Research done by the pharma companies is inherently bad.
Let’s review one at a time:
1. I have had patients report serious violations of legal and moral/ethical conduct of more than thirty therapists, ranging from sexual abuse to encouraging “cult” membership. In the few cases where the individual is well enough and has the necessary courage to do so, reporting of the behaviors have led to slaps on the wrists up to criminal prosecution. At least the pills come with some warning labels. It is very hard to research the effectiveness of therapy, but I encourage anyone with significant mental illness, loss of coping effectiveness or on psychoactive medication to undergo therapy. The pills are cheap compared to therapy and many people are uncomfortable talking about their problems. The good prescriber is knowledgeable of the cost and availability of therapy as well as medicines and seeks efficacy from both. It is hard to evaluate your community’s therapists in any objective way.
2. Medication helps some people, does not help others and has the potential for harm if not judiciously prescribed. The same holds for therapy. Some therapists are good, some are not, and some may harm a person if they are not careful. I encourage every patient to permit their therapist to consult with me and me to consult with the therapist. I will not support a therapeutic relationship without checks and balances. This policy also extends to every medical specialist I refer a patient to. I can’t safely work with a patient who gives me selected excerpts from their healthcare story.
3. Pills are not all the same. Therapy for any disorder must be customized to the patient. The serotonin, norepinepherine and dopamine drugs and their combinations have various shades of effectiveness. It is a great pleasure to me and colleagues to see a chronically disabled patient become functional, even happy, when pharmaceuticals work and extremes of behavior (especially if they have caused incarceration or commitment) are controlled. I am equally happy if that result comes about from non-pharmaceutical treatment.
4. Research funding by pharma is a two edged sword. We will get better results when we start applying criminal sanctions to those who withhold data or impeded to public’s right to know. In the interim, at least we know about pharma. They are capitalist companies doing what earns their share holders the best return available for their investments. The replacement will either be taxpayer support or a direct relationship between America’s research universities and pharma. If you think the military industrial complex is scary, academia and pharma will definitely keep you up at night. When the publish or perish crowd takes over we will suffer under the weight of poor quality research timed to run on grant cycles. We will all long for the days when pharma hired the output of our universities to do their research and there was at least the appearance of an arms length of separation.
Finally, the bottom line: We want the best healthcare at Wal-Mart prices. Someone has to pay the piper if this nation if to remain a leader in biomedical research and quality of medical care.

]]> By: sandy http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-382230 sandy Thu, 20 Nov 2008 01:24:35 +0000 http://www.pharmalot.com/?p=17750#comment-382230 I have been on many diferent antidepressants and they are not all the same they may all be bad but that is as far as I will go. I have been on many diferent antidepressants and they are not all the same they may all be bad but that is as far as I will go.

]]> By: sandy http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-382228 sandy Thu, 20 Nov 2008 01:21:43 +0000 http://www.pharmalot.com/?p=17750#comment-382228 Right off the bat if pharma is putting out a notice that says all antidepressants are the same. That translates in my brain to mean pharma is going to have a court case coming up big that says one of these drugs or a couple are worse than the rest and causing serious harm. Some class action suit somewhere. That is my guess. Any research is pharma research in my opinion the research industery cannot be separated from pharma too late for that no matter what our wish list is. Right off the bat if pharma is putting out a notice that says all antidepressants are the same. That translates in my brain to mean pharma is going to have a court case coming up big that says one of these drugs or a couple are worse than the rest and causing serious harm. Some class action suit somewhere.
That is my guess.

Any research is pharma research in my opinion the research industery cannot be separated from pharma too late for that no matter what our wish list is.

]]> By: MedsVsTherapy http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-382154 MedsVsTherapy Wed, 19 Nov 2008 17:04:31 +0000 http://www.pharmalot.com/?p=17750#comment-382154 oh yeah - I almost forgot to mention this curiosity in the authors' statement regarding any COI: all possible COI were reviewed, discussed, and "resolved." What does "resolved" mean? If you have a dog in the hunt, you have a dog in the hunt. So be it resolved that the lead author and possibly others have a dog in the hunt. OK, I have resolved this COI for myself. oh yeah - I almost forgot to mention this curiosity in the authors’ statement regarding any COI: all possible COI were reviewed, discussed, and “resolved.” What does “resolved” mean?

If you have a dog in the hunt, you have a dog in the hunt. So be it resolved that the lead author and possibly others have a dog in the hunt. OK, I have resolved this COI for myself.

]]> By: MedsVsTherapy http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-382153 MedsVsTherapy Wed, 19 Nov 2008 16:54:15 +0000 http://www.pharmalot.com/?p=17750#comment-382153 This is a great blog. Hopefully, we'll have good comments on this study. The lead author has ties to Endo, a company involved in getting FDA approval for SSRIs for pain. Not-too-surprisingly, the article takes a walk through the range of symptom clusters, including pain, that can accompany depression. Additionally: funding is noted as being through the Ann Int Med parent institution, ACP. ACP publishes Ann Int Med and other products with funding largely from pharmaceutical companies. The most curious part of the story, however, is how they side-step the issue of overall effficacy, about 40%, and briefly dismiss the issue of psychotherapy as a treamtent for depression with greater efficacy, but nowhere near the side effect / adverse events profile. So, this leads me to believe: just another marketing effort masquerading as research. This is a great blog. Hopefully, we’ll have good comments on this study. The lead author has ties to Endo, a company involved in getting FDA approval for SSRIs for pain. Not-too-surprisingly, the article takes a walk through the range of symptom clusters, including pain, that can accompany depression.

Additionally: funding is noted as being through the Ann Int Med parent institution, ACP. ACP publishes Ann Int Med and other products with funding largely from pharmaceutical companies.

The most curious part of the story, however, is how they side-step the issue of overall effficacy, about 40%, and briefly dismiss the issue of psychotherapy as a treamtent for depression with greater efficacy, but nowhere near the side effect / adverse events profile.

So, this leads me to believe: just another marketing effort masquerading as research.

]]> By: Ann Blake-Tracy, PhD http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-382135 Ann Blake-Tracy, PhD Wed, 19 Nov 2008 15:09:13 +0000 http://www.pharmalot.com/?p=17750#comment-382135 Thank you very much for this article Ed. It is about time there is some admission to the fact that there is no difference in these antidepressants. For years I have said that in lectures, radio shows, TV and news interviews and written it in newsletters and my book on these drugs. All antidepressants work the same, despite what marketing says, so why would the results be any different? So when we have evidence that one of these drugs has "homicidal ideation" listed as a side effect and one of the makers knew that their SSRI caused suicide at EIGHT TIMES the rate of placebo, what does that tell us about this entire group of drugs? It tells us clearly that the risk to benefit ratio is off the scale on the risk side and these drugs need to be pulled from the market-exactly what I have said for almost two decades! BUT they should be pulled with caution by stopping new prescribing and withdrawing current users gradually, not abruptly, as was the tragic case with the serotonergic diet pills Fen-phen and Redux. Ann Blake-Tracy, PhD, Executive Director, International Coalition for Drug Awareness www.drugawareness.org & author: Prozac: Panacea or Pandora? - Our Serotonin Nightmare Thank you very much for this article Ed. It is about time there is some admission to the fact that there is no difference in these antidepressants. For years I have said that in lectures, radio shows, TV and news interviews and written it in newsletters and my book on these drugs.

All antidepressants work the same, despite what marketing says, so why would the results be any different? So when we have evidence that one of these drugs has “homicidal ideation” listed as a side effect and one of the makers knew that their SSRI caused suicide at EIGHT TIMES the rate of placebo, what does that tell us about this entire group of drugs?

It tells us clearly that the risk to benefit ratio is off the scale on the risk side and these drugs need to be pulled from the market-exactly what I have said for almost two decades! BUT they should be pulled with caution by stopping new prescribing and withdrawing current users gradually, not abruptly, as was the tragic case with the serotonergic diet pills Fen-phen and Redux.

Ann Blake-Tracy, PhD, Executive Director,
International Coalition for Drug Awareness
http://www.drugawareness.org & author: Prozac: Panacea or Pandora? - Our Serotonin Nightmare

]]> By: drugs http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-382107 drugs Wed, 19 Nov 2008 03:00:49 +0000 http://www.pharmalot.com/?p=17750#comment-382107 Such a lot of controversy over 'drugs'. Thats all they are. Drugs. Drugs that people want and which is why they can't say no. Thats why they're still on the market. Thats why there's a controversy. Why they're still being prescribed. Why there's such a battle. Because they're drugs, acceptable drugs, legal drugs, and drugs that - like other legal drugs like alcohol and cigarettes - are something people will fight to keep, because to be without access to drugs is just too much for us, the people. DRUGS-R-US. The People. They're here because we the people want drugs. And thats something we all deny. Who wants to admit they're only on the market, like alcohol and cigarettes, because WE the people can't bear to admit we need drugs? Protecting them because they're called medicines is our one feeble excuse to defend them. Such a lot of controversy over ‘drugs’.

Thats all they are.

Drugs. Drugs that people want and which is why they can’t say no. Thats why they’re still on the market. Thats why there’s a controversy. Why they’re still being prescribed. Why there’s such a battle.

Because they’re drugs, acceptable drugs, legal drugs, and drugs that - like other legal drugs like alcohol and cigarettes - are something people will fight to keep, because to be without access to drugs is just too much for us, the people.

DRUGS-R-US. The People. They’re here because we the people want drugs.

And thats something we all deny. Who wants to admit they’re only on the market, like alcohol and cigarettes, because WE the people can’t bear to admit we need drugs?

Protecting them because they’re called medicines is our one feeble excuse to defend them.

]]> By: Anne PME http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-382096 Anne PME Wed, 19 Nov 2008 02:05:26 +0000 http://www.pharmalot.com/?p=17750#comment-382096 While ties to pharmacuetical companies need to be disclosed, ties to insurance companies and PBMs do not. Given that one of the factors to consider is cost, it would be interesting to know if any of the authors, including the authors with ties to pharma have ties to insurers or PBMs. Unfortunately, information about financial ties to the PBM- insurance indistry is tightly guarded and often protected as a 'trade secret'. While ties to pharmacuetical companies need to be disclosed, ties to insurance companies and PBMs do not. Given that one of the factors to consider is cost, it would be interesting to know if any of the authors, including the authors with ties to pharma have ties to insurers or PBMs. Unfortunately, information about financial ties to the PBM- insurance indistry is tightly guarded and often protected as a ‘trade secret’.

]]> By: Meg http://www.pharmalot.com/2008/11/if-youve-seen-one-antidepressant/#comment-382070 Meg Tue, 18 Nov 2008 19:40:32 +0000 http://www.pharmalot.com/?p=17750#comment-382070 The total number of acceptable suicides or homicides from the SSRIS (or anticonvulsants or atypical antipsycotics or or) is zero. It would be interesting to count up which was the drug of choice on "SSRI Stories" and see if there is a "winner". As for this "study", I would say balderdash - it was a pharma money study and therefore not to be trusted. The total number of acceptable suicides or homicides from the SSRIS (or anticonvulsants or atypical antipsycotics or or) is zero. It would be interesting to count up which was the drug of choice on “SSRI Stories” and see if there is a “winner”. As for this “study”, I would say balderdash - it was a pharma money study and therefore not to be trusted.

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