Falling STAR*D?: It is common practice for psychiatrists to switch depressive patients between different antidepressants if their current drug does not evince a symptomatic response. Despite clinical wisdom supporting this, little empirical, controlled evidence exists to direct “switching” protocols (e.g. if a patient with Z characteristics is on drug X, is it usually better to switch to drug A, B, or C? Will switching help at all?) in the psychopharmacological treatment of depression. The NIMH-funded
STAR*D (Sequenced Alternatives to Relieve Depression) study aimed to address these questions of treatment direction in a very large (n>4000), “real-world” sample using a
multi-phase treatment plan with different drugs (and cognitive therapy) at every step to maximize chances of eventual remission. Overall, the NIMH reported that about
67% of patients eventually achieved remission,
with few differences in effectiveness between different types of treatment at each step. However, researchers and commentators have
raised concerns regarding inconsistent reporting of outcomes, after-the-fact changes in
study design and analysis, and other issues that may have inflated, partially invalidated, or misrepresented widely reported treatment outcomes. These inequities may also have implications for the secondary moderator analyses (i.e. does trait A predict switching to X or Y is better?) that were a major reason for the study.
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posted by Keter
on Jan 14, 2012 -
12 comments
The Fat Trap (NYT pop review): Overweight individuals in Western nations (
and, increasingly, beyond) face interpersonal and
institutional stigma for their bodies*. Oftentimes, these stigmas are predicated on the belief that being overweight is a
moral failure, that being overweight is usually a result of laziness, decadence, and/or characterlogical poor impulse control. However, an emerging consensus among obesity researchers points toward
strong, common physiological and individual genetic factors as causative for heightened BMIs in the modern world and the general failure of dieting to produce BMI outcomes.
A recent study in the New England Journal of Medicine (paywalled) adds to this body of evidence, suggesting that chemical messengers held to contribute to altered "efficient" metabolism and increased hunger in the wake of low-calorie dieting are (on average) significantly elevated up to a full year (if not longer) following a substantial drop in weight from dieting.
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posted by Keter
on Dec 28, 2011 -
173 comments
