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.
[more inside]
posted by Keter
on Jan 14, 2012 -
12 comments
The Triumph of New-Age Medicine "Medicine has long decried acupuncture, homeopathy, and the like as dangerous nonsense that preys on the gullible. Again and again, carefully controlled studies have shown alternative medicine to work no better than a placebo. But now many doctors admit that alternative medicine often seems to do a better job of making patients well, and at a much lower cost, than mainstream care—and they’re trying to learn from it." [more inside]
posted by zarq
on Jun 15, 2011 -
278 comments
“It would be completely unethical to give the
drug to someone else,” he said, “but if you’re in a marriage and want to maintain that relationship, you might take a little booster shot yourself every now and then. Even now it’s not such a far-out possibility that you could use drugs in conjunction with marital therapy.”
posted by badego
on Jan 13, 2009 -
42 comments
"An autopoietic system is one organised to respond to the world. Prod it and it will react homeostatically, striving to reach a new accommodation that preserves its integrity. There is a global cohesion - a memory of what the system wants to be - that reaches down to organise the parts even while those parts may be adding up to produce the functioning whole."
posted by all-seeing eye dog
on Mar 17, 2005 -
29 comments
No pain, no gain, they say, and when it comes to real pain, the
inverse is true as well.
"
We
now have research indicating there's a memory of chronic pain,"
said Dr. Doris K. Cope, director of chronic and cancer pain for the
University of Pittsburgh Medical Center. It changes the genic code
sometimes, it changes the biochemistry, and it causes new proteins to
be formed." Or in other words, the more pain you have, the more pain you have. (
More on this.) It's no wonder, then, that more money is spent on pain relief than any other medical problem, and that there has been so much
pain research and so many
clinical trials revealing such painful facts as
redheads feel more pain,
men feel less pain, and that there's a
genetic difference between tough guys and wimps. (Much more pain inside.)
posted by taz
on Sep 20, 2004 -
31 comments
The
mind-body divide in medicine, whether having medicine embrace the understanding of the psychological aspects of symptoms of pain, for example, is simply a matter of working toward medicalizing psychology. How much is the brain and psychology taken into account in the medical profession?
posted by semmi
on May 6, 2002 -
8 comments
Utah Leads Nation in Rate of Anti-Depressant Use. It is interesting (to me) in that the people doing the study credit a "Mother of Zion" syndrome of married Mormon women putting on the happy face regardless of how happy they truly are. My state is up at the top also. Could be all the rain I guess. . .*sigh*
posted by Danf
on Feb 20, 2002 -
45 comments
What if the 'placebo effect' is as unreal as a sugar pill? Danish researchers who have looked at 114 clinical trials involving placebos found "little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos." News links
here and
here.
posted by pracowity
on May 25, 2001 -
13 comments
