Setanta
 
  1  
Reply Wed 25 Apr, 2012 05:42 am
I couldn't find anything at CBC (they may not have the interview up on their website yet), but i did find an article at the Toronto Sun. I'll look around to see if i can find something other than a journalistic summary.
Setanta
 
  1  
Reply Wed 25 Apr, 2012 05:45 am
Bingo!

Cool . . . Paul Andrews' page at the McMaster University web site. This page has a link to the radio interview i heard this morning on the Metro Morning progam, and links for his papers.
0 Replies
 
sozobe
 
  1  
Reply Wed 25 Apr, 2012 05:47 am
@Setanta,
Here's the link I had in mind, from the first page.

http://www.nytimes.com/2012/04/22/magazine/the-science-and-history-of-treating-depression.html

Excerpt:

Quote:
In fact, the very theory for how these drugs work has been called into question. Nerve cells — neurons — talk to one another through chemical signals called neurotransmitters, which come in a variety of forms, like serotonin, dopamine and norepinephrine. For decades, a central theory in psychiatry has been that antidepressants worked by raising serotonin levels in the brain. In depressed brains, the serotonin signal had somehow been “weakened” because of a chemical imbalance in neurotransmitters. Prozac and Paxil were thought to increase serotonin levels, thereby strengthening the signals between nerve cells — as if a megaphone had been inserted in the middle.

But this theory has been widely criticized. In The New York Review of Books, Marcia Angell, a former editor of The New England Journal of Medicine, wrote: “After decades of trying to prove [the chemical-imbalance theory], researchers have still come up empty-handed.” Jonathan Rottenberg, writing in Psychology Today, skewered the idea thus: “As a scientific venture, the theory that low serotonin causes depression appears to be on the verge of collapse. This is as it should be; the nature of science is ultimately to be self-correcting. Ideas must yield before evidence.”

[...]

To measure this effect, Kirsch combined 38 trials that included patients who had been given antidepressants, placebos or no treatment and then applied mathematical reasoning to estimate how much the placebos contributed to the improvements in mood. The analysis revealed two surprises. First, when Kirsch computed the strength of the placebo effect by combining the trials, he found that 75 percent of an antidepressant’s effect could have been obtained merely by taking the placebo. When Kirsch and his collaborators combined the published and unpublished studies of anti­depressants (they obtained the unpublished data from the F.D.A. via the Freedom of Information Act), the effects of the antidepressants were even more diluted — in some cases, vanishingly so. Now, the placebo effect swelled to 82 percent (i.e., four-fifths of the benefit might have been obtained by swallowing an inert pill alone). Kirsch came to believe that pharmaceutical companies were exaggerating the benefits of antidepressants by selectively publishing positive studies while suppressing negative ones.

But there are problems in analyzing published and unpublished trials in a “meta-trial.” A trial may have been unpublished not just to hide lesser effects but because its quality was poor — because patients were enrolled incorrectly, groups were assigned improperly or the cohort sizes were too small. Patients who are mildly depressed, for example, might have been lumped in with severely depressed patients or with obsessive-compulsives and schizophrenics.

In 2010, researchers revisited Kirsch’s analysis using six of the most rigorously conducted studies on antidepressants. The study vindicated Kirsch’s conclusions but only to a point. In patients with moderate or mild depression, the benefit of an antidepressant was indeed small, even negligible. But for patients with the most severe forms of depression, the benefit of medications over placebo was substantial. Such patients might have found, as Andrew Solomon did, that they no longer felt “the self slipping out” of their hands. The most severe dips in mood were gradually blunted. Like Dorothy, these patients most likely still experienced sorrow, but they experienced it in ways that were less self-destructive or paralyzing. As Solomon wrote: “The opposite of depression is not happiness, but vitality, and my life, as I write this, is vital.”

These slippery, seemingly contradictory studies converge on a surprisingly consistent picture. First, patients with severe depression tend to respond most meaningfully to antidepressants, while patients with moderate or mild depression do not. Second, in a majority of those who do respond, serotonin very likely plays an important role, because depleting serotonin in depressed patients often causes relapses. And third, the brain-as-soup theory — with the depressed brain simply lacking serotonin — was far too naïve.


Setanta
 
  1  
Reply Wed 25 Apr, 2012 05:53 am
@sozobe,
sozobe's source wrote:
And third, the brain-as-soup theory — with the depressed brain simply lacking serotonin — was far too naïve.


There's the crux of the biscuit.
sozobe
 
  1  
Reply Wed 25 Apr, 2012 06:31 am
@Setanta,
Indeed.

Just was reading the paper and there's yet another article in the vein of the ones I've been posting. I'll just summarize this one since I've been cut+paste+link-ing so much (link on request): Even though strong recommendations were made in 2008 that men over 75 not continue to get prostate cancer screening, many still do. The recommendations were made because screening is more likely to do harm than good, for two main reasons; first, older men naturally have elevated PSA levels, and second, because any cancer that shows up after age 75 is likely to be so slow-growing that it would never cause any harm.

Meanwhile, unnecessary treatment could cause pain, incontinence, and impotence, among other things.
0 Replies
 
boomerang
 
  1  
Reply Wed 25 Apr, 2012 11:50 am
Yesterday my paper reported (yet another) young boy falling over dead during sports practice. This boy was 12.

I always find myself wondering if there is a connection to ADD/ADHD drugs when this happens.

I've read that the largest (American) study says that there isn't a connection. But it always seems to be young boys and they are almost always athletic. You'd think their hearts would be strong.

As I understand it, stimulants lower heart rate and increase blood pressure and therefore all these drugs list dangers to heart function as a side effect.

But there is "no connection"....

The UK and Canada have serious restrictions on the use of stimulants, partly due to the heart problems.

I wonder what the truth is about all of this.
sozobe
 
  1  
Reply Wed 25 Apr, 2012 12:07 pm
@boomerang,
I saw that too, really sad!

Evidently he had a heart attack three months ago (during a basketball game), then surgery, then was supposed to be fine. There is some question about whether he should've been back playing sports so soon. Dunno.
0 Replies
 
DrewDad
 
  1  
Reply Wed 25 Apr, 2012 12:09 pm
@boomerang,
I suspect it's the "always athletic" part that's the biggest link; it always seems to happen during sports.
ossobuco
 
  1  
Reply Wed 25 Apr, 2012 01:20 pm
@DrewDad,
I've been following sports forever and this has happened lots of times over the years. Think that famous marathon runner and promoter, Jim something. I haven't looked at stats to see what increases there are and what any coroners (etc) said. People sometimes have undiagnosed heart valve stuff.

I think it would be hard to pin point - increasingly sharp records, changes in conditioning, changes in coaches pushing athletes in heat, changes or failure to be changes in physicals given to athletes, changes in energy products, athletics related meds, doping, and then possible other meds. Athletes being taller (some talls have heart related issues crop up).
0 Replies
 
ehBeth
 
  1  
Reply Wed 25 Apr, 2012 01:52 pm
@boomerang,
boomerang wrote:
The UK and Canada have serious restrictions on the use of stimulants, partly due to the heart problems.


and young athletes die on the field here as well

I'm always startled by how many undiagnosed heart conditions there seem to be.
0 Replies
 
 

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