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Mind

Neuroskeptic Voted Person of The Year

Neuroskeptic iconNeuroskepticBy NeuroskepticMay 7, 2009 7:11 AM

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...well, not quite. At least not yet. But I have been linked to by Time Magazine.

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The Time article discusses a paper that I also blogged about recently, Can Phase III Trial Results of Antidepressant Medications Be Generalized to Clinical Practice? A STAR*D Report

In a nutshell, this paper found that out of a large sample of depressed people who are fairly representative of the general population of patients presenting with depression in America, only 22% would have been accepted into a typical antidepressant trial. They were on average richer, better educated, more likely to have a job, and less likely to be black or Hispanic. In other words, typical antidepressant trials only recruit a narrow cross-section of society, tending to exclude the poor and disadvantaged and those with multiple mental health problems.

The study also found that this 22% tended to report a better response to an antidepressant, citalopram, than the rest. But as I said at the time...

Does this mean that rich white people really get more benefit from citalopram? Or do they just tend to report more benefit? Or do they experience larger placebo effects? It's impossible to say.

One of the problems with the this trial was that there was no placebo group. So the fact that the select 22% reported better response doesn't mean that they actually experienced a more powerful drug effect. It's entirely possible (and I would say, likely) that they could be just the kind of people who like to play along, comply with expectations and report greater benefits, for example. Whereas in fact they might have done equally well without any drugs, whereas the people who reported a smaller benefit might have done even worse with no treatment. We just don't know.

So when Time says that

a major new study suggests that both critics and proponents might be right about SSRIs: the drugs can work, but they appear to work best for only a subset of depressed patients — those with a limited range of psychological problems. People whose depression is compounded with, say, substance abuse or a personality disorder may not get much help from SSRIs —

That's one possibility, but not the only one.

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