Prozac works for me!

[Badly Shaved Monkey]

No I don't mean it in that way. And with apologies to andyandy (http://forums.randi.org/showthread.php?t=107400), I thought it was worth a different thread for a different idea.

Because, Prozac works very well for me as a rhetorical device.

If SSRIs are no better than placebo or only trivially better than placebo, I expect doctors will feel frustration at having been mistaken or annoyance if they have been misled by the drug companies, what they will not feel is shocked surprise. This information will get bedded into their management of patients. They will prescribe, perhaps, to a narrower set of patients and reconsider the case histories of patients who perhaps would not have needed the drug.

What they will not do is refuse to believe in the possibility that they were mistaken to see clinical benefits from these drugs. They will not appeal to the fact of millions of people reporting they felt better. They will not appeal to the fact that SSRIs were a mass existing concept/system in well distributed public since long with least adversities (http://forums.randi.org/showthread.php?t=37460&page=3). They will not appeal to some dead German whose 200-year old holy book tells them that the drugs work.

What would a homeopath do given the same information about their remedies? Indeed, what do we see the homeopaths doing all the time?

[Deetee]

They will not appeal to the fact that SSRIs were a mass existing concept/system in well distributed public since long with least adversities (http://forums.randi.org/showthread.php?t=37460&page=3).

Thought you'd got carried off in a wave of pseudoscientific neologism there, BSM. Now I see it was just a phrase in Kumarese.

[Blue Wode]

What would a homeopath do given the same information about their remedies? Indeed, what do we see the homeopaths doing all the time?


Carrying on regardless, just like the chiros…

January 2007 (General Chiropractic Council’s website)
Advice for General Practitioners, Primary Care Trusts and Local Health Boards

The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention, including manipulation, is safe, effective and cost-effective in reducing referral to secondary care.

http://www.gcc-uk.org/files/page_file/GP%20Care%20Pathway.pdf




…despite growing scientific evidence to the contrary:

2008
The core concepts of chiropractic, subluxation, and spinal manipulation, are not based on sound science…Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.

http://www.ncbi.nlm.nih.gov:80/pubmed/18280103?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum


2003
The results available to date suggest that the therapeutic success of spinal manipulation is largely due to a placebo effect.

http://fampra.oxfordjournals.org/cgi/content/full/17/6/554

[JoeEllison]

No I don't mean it in that way. And with apologies to andyandy (http://forums.randi.org/showthread.php?t=107400), I thought it was worth a different thread for a different idea.

Because, Prozac works very well for me as a rhetorical device.

If SSRIs are no better than placebo or only trivially better than placebo, I expect doctors will feel frustration at having been mistaken or annoyance if they have been misled by the drug companies, what they will not feel is shocked surprise. This information will get bedded into their management of patients. They will prescribe, perhaps, to a narrower set of patients and reconsider the case histories of patients who perhaps would not have needed the drug.

What they will not do is refuse to believe in the possibility that they were mistaken to see clinical benefits from these drugs. They will not appeal to the fact of millions of people reporting they felt better. They will not appeal to the fact that SSRIs were a mass existing concept/system in well distributed public since long with least adversities (http://forums.randi.org/showthread.php?t=37460&page=3). They will not appeal to some dead German whose 200-year old holy book tells them that the drugs work.

What would a homeopath do given the same information about their remedies? Indeed, what do we see the homeopaths doing all the time?
I see what you mean. The first thing scientists will do is analyze the data, and see if they come up with the same results. New trials may be called for, and use of Prozac restricted until those trials are completed.

If the new round of trials fail to show any effect for Prozac, it will be pulled off the market... and this situation will be taught in medical, psychiatric, and pharmaceutical schools as a warning and a demonstration of how science is self-correcting.

What they will NOT do is shrug their shoulders, cite anecdotes, and continue with Prozac as though there's no evidence against its effectiveness. That sort of behavior is reserved for the woosters.

[rjh01]

When I heard the defence of Prozac yesterday I thought it sounded like any alternative health claims. They basically said there was no evidence that it worked. Worse it is addictive.

[Kiosk]

If the new round of trials fail to show any effect for Prozac, it will be pulled off the market...

Excuse my pedantry, but I doubt Prozac or any other SSRI would be actually pulled from the market - rather, there may be a halt to new prescriptions with a view to phasing out manufacture at some point in the future. The dependence factor has to be taken into account here, for a start. Suddenly yanking a drug off the market when thousands or millions of people around the world are unable to successfully withdraw from that drug is just not feasible.

A possibly more interesting question is: if it were shown to be non-effective, a pure placebo, what about the fact that lots of people think it works for them? If someone's convinced that the only thing standing between them and the abyss is their Prozac... even if they're wrong... is it more ethical to continue to prescribe it, or to say "sorry, the tests have spoken, you'll have to stop being so silly and admit that this drug you think has been helping you actually hasn't been helping you at all - now hand over that bottle."

Whatever the efficacy of SSRIs, no one can say they're inert. They cause a raft of mental and physical changes, and can have wildly different effects on different people (for instance, they're known to cause weight gain in most users, but sertraline caused me to lose weight and stay slim; similarly, they're known as passion killers and impotence inducers, and while Prozac certainly had that effect on me when I tried it briefly, sertraline turned me into a raving sex maniac). If new tests were to show next-to-no significant efficacy for depression across the board, it would still be possible to argue that the beneficial effect for many patients was more than just a placebo, because even if the drug did not directly reverse their depression by tinkering with serotonin re-uptake, there may have been some neurological effect which they found agreeable which contributed to increased well-being generally, and helped facilitate their recovery. The placebo issue here is vastly more complex than in homeopathy, for instance.

[rjh01]

Maybe there is a role for homeopathy to cure depression after all? Or maybe certain people just need someone, who is a good listener, to talk to?

[orpheus]

Excuse my pedantry, but I doubt Prozac or any other SSRI would be actually pulled from the market - rather, there may be a halt to new prescriptions with a view to phasing out manufacture at some point in the future. The dependence factor has to be taken into account here, for a start. Suddenly yanking a drug off the market when thousands or millions of people around the world are unable to successfully withdraw from that drug is just not feasible.

A possibly more interesting question is: if it were shown to be non-effective, a pure placebo, what about the fact that lots of people think it works for them? If someone's convinced that the only thing standing between them and the abyss is their Prozac... even if they're wrong... is it more ethical to continue to prescribe it, or to say "sorry, the tests have spoken, you'll have to stop being so silly and admit that this drug you think has been helping you actually hasn't been helping you at all - now hand over that bottle."

Whatever the efficacy of SSRIs, no one can say they're inert. They cause a raft of mental and physical changes, and can have wildly different effects on different people (for instance, they're known to cause weight gain in most users, but sertraline caused me to lose weight and stay slim; similarly, they're known as passion killers and impotence inducers, and while Prozac certainly had that effect on me when I tried it briefly, sertraline turned me into a raving sex maniac). If new tests were to show next-to-no significant efficacy for depression across the board, it would still be possible to argue that the beneficial effect for many patients was more than just a placebo, because even if the drug did not directly reverse their depression by tinkering with serotonin re-uptake, there may have been some neurological effect which they found agreeable which contributed to increased well-being generally, and helped facilitate their recovery. The placebo issue here is vastly more complex than in homeopathy, for instance.


Well said. From personal experience of a whole range of antidepressants, I think you've clearly articulated some important points.

[JoeEllison]

Excuse my pedantry, but I doubt Prozac or any other SSRI would be actually pulled from the market - rather, there may be a halt to new prescriptions with a view to phasing out manufacture at some point in the future.
Well, yes... I didn't mean that they would collect all the Prozac next month, and burn it all at a public bonfire. :cool: Obviously, there would be a transition period. The point I was trying to make is that, unlike homeopathic "remedies," if Prozac were found to be useless, it would eventually be removed from the market. The same cannot be said for the homeopathic remedies that have been shown to have effect indistinguishable from placebo.

[Deetee]

A possibly more interesting question is: if it were shown to be non-effective, a pure placebo, what about the fact that lots of people think it works for them? If someone's convinced that the only thing standing between them and the abyss is their Prozac... even if they're wrong... is it more ethical to continue to prescribe it, or to say "sorry, the tests have spoken, you'll have to stop being so silly and admit that this drug you think has been helping you actually hasn't been helping you at all - now hand over that bottle."Interesting to ponder whether the placebo effect will disappear if people think the drug was only working because it acted as a placebo.

[JoeEllison]

Interesting to ponder whether the placebo effect will disappear if people think the drug was only working because it acted as a placebo.

Yeah, but can we really trust the nuts who are on Prozac in the first place?:boggled:

Who wants to bet that this is the argument that the pharmaceutical companies go with?

[brodski]

Yeah, but can we really trust the nuts who are on Prozac in the first place?:boggled:

Who wants to bet that this is the argument that the pharmaceutical companies go with?no the arument they will go wih is that thee ADs showed a ststically significant improvment ovt pacebo- beceause that's what the data, inculding this mot recent review, show.

The argument is that for less than severe depression the results arn't clinically significant. Prozac works, just not well...

[Ivor the Engineer]

Maybe there is a role for homeopathy to cure depression after all? Or maybe certain people just need someone, who is a good listener, to talk to?

Therapist = Paid friend.

[Cainkane1]

I took prozac once and all it did was reduce my manhood to nothing. I don't know what it does to women.

[Mojo]

Give us back our placebos (http://www.theherald.co.uk/features/letters/display.var.2075346.0.Placebos_our_voodoo.php)! When I started in general practice 25 years ago we had a range of placebos which were cheap and popular. There was a green tonic that tasted absolutely foul and I used to prescribe bucketloads of the stuff. But then the health police came along with a blacklist and all these cheap and useful medicines were consigned to history. Please sir, can we have our tonics back again?

[Mojo]

And responses (http://www.theherald.co.uk/features/letters/display.var.2078613.0.Take_care_not_to_disparage_a ntidepressants.php).

[Dancing David]

No I don't mean it in that way. And with apologies to andyandy (http://forums.randi.org/showthread.php?t=107400), I thought it was worth a different thread for a different idea.

Because, Prozac works very well for me as a rhetorical device.

If SSRIs are no better than placebo or only trivially better than placebo, I expect doctors will feel frustration at having been mistaken or annoyance if they have been misled by the drug companies, what they will not feel is shocked surprise. This information will get bedded into their management of patients. They will prescribe, perhaps, to a narrower set of patients and reconsider the case histories of patients who perhaps would not have needed the drug.

What they will not do is refuse to believe in the possibility that they were mistaken to see clinical benefits from these drugs. They will not appeal to the fact of millions of people reporting they felt better. They will not appeal to the fact that SSRIs were a mass existing concept/system in well distributed public since long with least adversities (http://forums.randi.org/showthread.php?t=37460&page=3). They will not appeal to some dead German whose 200-year old holy book tells them that the drugs work.

What would a homeopath do given the same information about their remedies? Indeed, what do we see the homeopaths doing all the time?


Gosh, that is a rather sweeping statement, I wonder is the scale used to measure the benefit of the medication an appropriate scale for measuring symptom relief, the BDI is good for saying someone has depression as was the scale used in the other study.

However they may not be a tool for determing if the ADs have a benefit. Is a common bathroom scale good for measuring the wieght difference of a puppy and a baby human?

Now are all ADs good for every person, absolutely not. Is diagnosis an accurate prediction of response to treatement, depends on the psychitraist and the history the consumer gives.

[Dancing David]

no the arument they will go wih is that thee ADs showed a ststically significant improvment ovt pacebo- beceause that's what the data, inculding this mot recent review, show.

The argument is that for less than severe depression the results arn't clinically significant. Prozac works, just not well...

Only if you use a gross scale to determine benefit, in measurement the scale must be appropraite to the event being measured.

[Dancing David]

Therapist = Paid friend.

Only if they are a bad therapist, the only therapy that is proven effective is cognitive behavioral, the rest are psychodrama, coaching or worthless.

[Thurkon]

Well, yes... I didn't mean that they would collect all the Prozac next month, and burn it all at a public bonfire. :cool: Obviously, there would be a transition period. The point I was trying to make is that, unlike homeopathic "remedies," if Prozac were found to be useless, it would eventually be removed from the market. The same cannot be said for the homeopathic remedies that have been shown to have effect indistinguishable from placebo.

Did you see the results of the study? Prozac was not deemed "useless", just less effective at treating mild depression. It is effective at treating more severe cases.

Let's not be guilty of parroting the sensationalist headlines that distort truth to sell papers...

[Kiosk]

Yeah, but can we really trust the nuts who are on Prozac in the first place?:boggled:

Who wants to bet that this is the argument that the pharmaceutical companies go with?

Well that's the argument they've been using for the last fifteen years to smear everyone who's developed severe issues after withdrawing from the stuff...

[Leicontis]

...sertraline caused me to lose weight and stay slim; similarly, they're known as passion killers and impotence inducers, and while Prozac certainly had that effect on me when I tried it briefly, sertraline turned me into a raving sex maniac...
Weight-loss drug and aphrodisiac? That'll improve anyone's mood! :D

[Kiosk]

And it did. You see what I mean?

The temporary hypomania was nice, too. I do think perhaps a doctor should have noticed it, though...

[Dancing David]

And it did. You see what I mean?

The temporary hypomania was nice, too. I do think perhaps a doctor should have noticed it, though...


And warned you about the potential.

[Kiosk]

Yes, exactly.

That hypomania lasted only a few weeks at the start of treatment, but in retrospect it was clearly a warning sign. I just took it as "feeling great", a boost from having my depression relieved. It was only later that I thought back and realised that three weeks spent running around one's flat like a boisterous child, bouncing up and down on one's bed cheering, and walking through the woods pointing at trees saying "oh my God, isn't this all so amazing, there's so much to do in the world, I'm so happy" - coupled with four hours' sleep a night - is not a good sign when changing doses of medication.

Unfortunately, I wasn't seeing a psychiatrist and my regular doctor (who suggested the dosage change) didn't ask me any questions more probing than "are you feeling better?" I most certainly was, so I said "yes". End of consultation.

I think it's extremely likely that my severe adverse reaction to discontinuation was foreshadowed by this hypomanic response. Certainly, any responsible medical type would raise an eyebrow. Not everyone who responds that badly to withdrawal had issues on starting the meds, but everyone who had those issues when starting is surely running an increased risk of something bad happening later, if they continue taking the same stuff. I suspect the inability (or sometimes, unwillingness) of medical professionals to follow this kind of thing up is often a large part of the problem.

I seem to have met a worryingly high number of doctors who get their only information about drugs from drug reps and the like. Now, I'm well aware that no doctor has time to read up obsessively on every single thing they prescribe, but when patients are saying, for instance, "I came off this drug and I've felt like I'm on a bad acid trip for the last three months", the response should perhaps display a little more curiosity and concern than "no, there is no withdrawal from these drugs, your problem is that you need to go back on the drug and take it for the rest of your life... even though you just pooped-out on the highest recommended dose". Trouble is, when that's the official line from pharma, this kind of response is almost inevitable.

[calebprime]

derail for Kiosk:D

Here to play Tchaikowsky's first piano concerto in B Flat Minor is the world-famous soloist Sviatoslav Richter. During the performance he will escape from a sack, three padlocks and a pair of handcuffs.

[Rolfe]

Back to BSM's original point. It's hard to figure what the SSRI study was really saying, but I think part of it was that while there were indeed statistically significant improvements to point to, these were clinically trivial.

Ring any bells?

All these contentious homoeopathy studies that the woos get so het up about, are all clinically trivial, even if you do accept that there's an effect there!

The reason we get so interested in their claims is that it's against the laws o' physics, Cap'n, for there to be anything measurable happening at all. But supposing that wasn't the issue. Supposing we weren't that worried about whether or not a beyond-Avogadro-limit dilution could affect a biological system.

Who really cares whether Oscilococcinum can shorten a cold by six hours, or whatever it was?

Rolfe.

[Deetee]

Back to BSM's original point. It's hard to figure what the SSRI study was really saying, but I think part of it was that while there were indeed statistically significant improvements to point to, these were clinically trivial.

Ring any bells?

All these contentious homoeopathy studies that the woos get so het up about, are all clinically trivial, even if you do accept that there's an effect there!

The reason we get so interested in their claims is that it's against the laws o' physics, Cap'n, for there to be anything measurable happening at all. But supposing that wasn't the issue. Supposing we weren't that worried about whether or not a beyond-Avogadro-limit dilution could affect a biological system.

Who really cares whether Oscilococcinum can shorten a cold by six hours, or whatever it was?

Rolfe.I think I'll wait for the dust to settle on this one and see whether there is any emerging scientific consensus that the study data mean what they appear to say. There already are some valid questions being raised about the conclusions or way in which the data are interpreted. In the other prozac thread (http://forums.randi.org/showpost.php?p=3480778&postcount=86), I linked to some of the relevant responses. It may be that there is a case for a clinically relevant difference between ADs and placebo (albeit a small one) after all.

One thing we know is that the drugs are pharmacologically active, and interfere with neurotransmitters in a way that would make a beneficial effect on depression plausible, so this differs greatly from the homeopathy/woo scenario.

PS - it was 0.28 days, BTW, (6.72 hours):)

[Mojo]

Who really cares whether Oscilococcinum can shorten a cold by six hours, or whatever it was?


Or whether homoeopathy can enable a child to pass one fewer loose stool on the 4th day of an attack of diarrhea, while achieving nothing else?

[Badly Shaved Monkey]

I think I'll wait for the dust to settle on this one and see whether there is any emerging scientific consensus that the study data mean what they appear to say. There already are some valid questions being raised about the conclusions or way in which the data are interpreted. In the other prozac thread (http://forums.randi.org/showpost.php?p=3480778&postcount=86), I linked to some of the relevant responses. It may be that there is a case for a clinically relevant difference between ADs and placebo (albeit a small one) after all.

One thing we know is that the drugs are pharmacologically active, and interfere with neurotransmitters in a way that would make a beneficial effect on depression plausible, so this differs greatly from the homeopathy/woo scenario.

PS - it was 0.28 days, BTW, (6.72 hours):)

That was the mean. The lower end of the confidence limits was 0.06d, i.e. 86.4mins.

I believe the phrase Big Fat Hairy Deal may be fairly deployed now.