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]
I took my video camera to a Foster Care Alumni meeting and asked seven foster kids to tell me about there experiences in Child Protective Services while wards of the state: Tristen, Andrew, Kyle, Aisha, Elnita, Ashley, Joshua. [more inside]
Anti-depressants increase suicide risk in young adults, FDA warns. "When results are analyzed by age, it becomes clear that there is an elevated risk for suicidality and suicidal behavior among adults younger than 25 years of age that approaches that seen in the pediatric population." More here and here. This follows the FDA finding that anti-depressants increased the risk of suicide in young children. The FDA now requires manufacturers of anti-depressants to include warnings, and plans to meet on Dec 13 to discuss the findings further.
It is America's most profitable industry, number one in return on revenues, return on assets, and return on equity. From barbiturates, to benzodiazepines, to everyone's favorite delysid, we come to the new age: SSRI's. There are thousands of studies showing that they work. And very few that question their efficacy. (very informative meta-analysis, a follow-up [pdf]). A quantitative explanation.
Zoloft Found Safe, Effective in Children The study was funded by Pfizer Inc., which makes Zoloft. Visit The International Coalition For Drug Awareness to find out what SSRI Meds can really do to your kids...