ANTIDEPRESSANTS: Star D Study – Only 3% Remission, Not 67%

Last paragraph reads:  “”Although the study‘s reports make no
mention of this outcome, their data show that after a year of continuation
treatment following remission, of the 4,041 patients who entered the program
only 108 (3%) had a sustained remission — all the other patients either dropped
out or relapsed. Yet STAR*D‘s authors and the NIMH have publicized the study as
showing a 67% success rate for

antidepressants.”

http://www.psychologytoday.com/blog/mad-in-america/201005/update-the-stard-report
May 19, 2010, Psychiatry

Update on the STAR*D Report
The
documented recovery rate in the STAR*D trial–worse than thought?
Published
on May 19, 2010

Two months ago, I wrote a post about a New Yorker
article that reported that 67% of the depressed patients in the STAR*D trial
“recovered.” As I noted in that post, the 67% figure was a highly exaggerated
number. Only 51% of the 3,671 patients who entered the trial ever remitted, even
for a short period. Furthermore, only about 20% of the patients remitted and
then reported to STAR*D investigators, at some point during a 12-month follow-up
period, that they were still doing well.

But this left an obvious
question, one that I hadn’t been able to find an answer to in the published

STAR*D reports. How many of the 3,671 people who entered the trial remitted and
then stayed well and in the trial throughout the entire 12-month follow-up? That
number would provide a documented long-term recovery rate for patients in the
trial.

A few days ago, Allan Leventhal sent me a 2009 article he
coauthored with David Antonuccio, and in it, they successfully identified this
number (finding it in a confusing graphic I hadn’t been able to decipher.) In
their computations, they relied on STAR*D reports that told of 4,041 initial
participants (3,671 was the number of “enrolled” patients counted in the
analysis of drug-remission rates), and then they came to this bottom-line
conclusion about the documented long-term recovery rate:

“Although the

study‘s reports make no mention of this outcome, their data show that after a
year of continuation treatment following remission, of the 4,041 patients who
entered the program only 108 (3%) had a sustained remission — all the other
patients either dropped out or relapsed. Yet STAR*D‘s authors and the NIMH have
publicized the study as showing a 67% success rate for antidepressants.”

424 total views, no views today

SSRIs: Sharp Drop in Brain Activity + Worsening Depression & Suicidality

NOTE BY Ann Blake-Tracy (www.drugawareness.org):

Hopefully if you have followed my work or read my book, “Prozac: Panacea or Pandora? – Our Serotonin Nightmare,” you know that I have made the argument for a decade and a half that antidepressants are the most similar drugs we have ever seen to dissociative anesthetics like PCP or Ketamine. They just work in a little slower motion is all. This research would confirm that by showing adrop in brain activity within ONLY 48 hours of use! All one needs to do is go to the one color page inmy book with brain wave patterns of a 31 year old male on Prozac for six months. The brain waves show that the patient is in a total anesthetic sleep state and dreaming while talking with those doing the test on him!
_______________________________________
Paragraph five reads:  “Prior research, Hunter said, has shown that between 8 and 14 percent of depressed patients develop thoughts of suicide while taking the most common forms ofdepression drugs, known as selective serotonin reuptake inhibitors (SSRI). Although reports have suggested that SSRIs are to blame, no firm link between these drugs and thoughts of suicide has been established.”

Paragraphs seven and eight read:  “The researchers treated 72 people suffering from majordepressive disorder (MDD) with one of two SSRIs, fluoxetine or venlafaxine, or with a placebo. All were evaluated by a clinician using the Hamilton Depression Rating Scale, a standard instrument that assesses the severity of a wide range of depression symptoms. Of the 37 participants on medication,five (13.5 percent) had worsening thoughts of suicide.”

“All of the participants were also examined using QEEG, which evaluates brain function based on thebrain‘s electrical activity. Among the 13.5 percent of participants who got worse, the researchersfound a sharp drop in brain activity within 48 hours of the start of medication. The dropoccurred in the midline and right-frontal sections of the brain, areas known to control emotions.”

SSRI Stories note:  In regard to placebo & suicidality, it should be remembered that the majority of placebo patients are ‘wash-out’ patients from other antidepressants and thus are actually inantidepressant withdrawal which can be extremely dangerous.

http://www.physorg.com/news189972383.html

Simple test can detect signs of suicidal thoughts in people taking antidepressants

April 8, 2010 By Mark Wheeler

(PhysOrg.com) — UCLA researchers have developed a non-invasive biomarker that may serve as a type of early warning system for doctors and patients.

While antidepressant medications have proven to be beneficial in helping people overcome majordepression, it has long been known that a small subset of individuals taking these drugs can actually experience a worsening of mood, and even thoughts of suicide. No clinical test currently exists to make this determination, and only time  usually weeks  can tell before a psychiatrist knows whether a patient is getting better or worse.

Now, UCLA researchers have developed a non-invasive biomarker, or indicator, that may serve as a type of early warning system.

Reporting in the April edition of the peer-reviewed journal Acta Psychiatrica Scandinavica, Aimee Hunter, an assistant research psychologist in the UCLA Department of Psychiatry, and colleagues report that by using quantitative electroencephalographic (QEEG), a non-invasive measurement of electrical activity in the brain, they were able to observe a sharp reduction of activity in a specific brainregion in individuals who proved susceptible to thoughts of suicide  within 48 hours of the start of treatment.

Prior research, Hunter said, has shown that between 8 and 14 percent of depressed patients develop thoughts of suicide while taking the most common forms of depression drugs, known as selective serotonin reuptake inhibitors (SSRI). Although reports have suggested that SSRIs are to blame, no firm link between these drugs and thoughts of suicide has been established.

This study suggests, for the first time, a link between worsening suicidality and specific changes inbrain function while on these medications.

The researchers treated 72 people suffering from major depressive disorder (MDD) with one of twoSSRIs, fluoxetine or venlafaxine, or with a placebo. All were evaluated by a clinician using the Hamilton Depression Rating Scale, a standard instrument that assesses the severity of a wide range of depression symptoms. Of the 37 participants on medication, five (13.5 percent) had worseningthoughts of suicide.

All of the participants were also examined using QEEG, which evaluates brain function based on thebrain‘s electrical activity. Among the 13.5 percent of participants who got worse, the researchers found a sharp drop in brain activity within 48 hours of the start of medication. The drop occurred in the midline and right-frontal sections of the brain, areas known to control emotions.

Of note, eight of the 35 participants taking a placebo (22.9 percent) also had increased thoughts of suicide. However, the placebo participants did not show the precipitous drop in brain activity within the first 48 hours.

“This is the first study to show a change in brain function after the start of medication that appears to be linked to the subsequent development of worsening thoughts of suicide during antidepressant treatment,” Hunter said. “Importantly, changes in this biomarker did not predict worsening suicidal thoughts in the placebo-treated subjects, so the results suggest that the biomarker specifically detected medication-related worsening only.”

QEEG is a relatively inexpensive instrument that is non-invasive; measurements are obtained by placing electrodes on the scalp. As a result, Hunter said, further development of this biomarker could potentially lead to a tool that could be used by clinicians to predict, in the early stages of treatment, whether an individual suffering from depression will develop thoughts of suicide.

Provided by University of California Los Angeles

620 total views, no views today

JAMA: Mild to severe depression better treated with alternatives to medications

Last month, a team at the University of Pennsylvania found only patients
with very severe depression were measurably helped by antidepressant drugs. Mild
to severe depression might be better treated with alternatives to antidepressant
drugs, they wrote in the Journal of the American Medical Association.


From: nandtbearden@yahoo.com
To: ,
ssri-crusaders@yahoogroups.com, atypical_antipsychotics@yahoogroups.com,
atracyphd2@aol.com
Sent: 2/14/2010 8:12:09 A.M. Central Standard
Time
Subj: Even when treated, depression costs employers

http://uk.mobile.reuters.com/mobile/m/FullArticle/eUK/CHLTUK/nhealthNews_uUKTRE6183DO20100209

Even
when treated, depression costs employers
Tue, 09 Feb 20:05 PM
GMT

WASHINGTON (Reuters) – Workers with depression stay home
sick more often than healthy colleagues, even when their disease is treated,
according to a Thomson Reuters report released on Tuesday.

The report,
commissioned by drug maker Sanofi Aventis, suggests that employers would
benefit from better treatments of their workers for depression. Depression is
the leading cause of disability among Americans aged 15 to 44, according to
the National Institute of Mental Health.

“Even when depressed patients
are treated with antidepressants, there are substantial productivity losses.
Therapies that can better manage depression may provide opportunities for
savings to employers,” the Thomson Reuters research team wrote in the Journal
of Occupational and Environmental Medicine.

“Despite the widely
acknowledged effectiveness of antidepressant therapy, productivity costs
related to depression persist even after patients receive treatment,” Suellen
Curkendall, director of outcomes research at Thomson Reuters, said in a
statement.

“This may be due to the fact that patients often don’t
respond to the first type of antidepressant that they are prescribed. They
also may fail to take their medications on a regular basis,” added Curkendall,
who led the study.

Curkendall and colleagues analyzed insurance claims
and employee health and productivity data for more than 22,000 patients
treated with antidepressants and compared them to people without
depression.

Workers who had been treated for depression were twice as
likely as others to use short-term disability leave, they found.
Disability-related costs for a year, on average, were $1,038 for patients
treated for depression and $325 for the non-depressed workers.

“Over 40
percent of patients with depression were diagnosed with at least one of the
other included psychiatric conditions besides depression,” the researchers at
Thomson Reuters, parent company of Reuters, added.

Most common were
anxiety, dissociative and so-called somatoform disorders — a group of
disorders with physical symptoms but no apparent physical cause.

Last
month, a team at the University of Pennsylvania found only patients with very
severe depression were measurably helped by antidepressant drugs. Mild to
severe depression might be better treated with alternatives to antidepressant
drugs, they wrote in the Journal of the American Medical
Association.

At least 27 million Americans take antidepressants and
more than 164 million prescriptions for antidepressants were written in 2008,
totaling nearly $10 billion in U.S. sales and $20 billion globally, according
to IMS Health.

(Reporting by Maggie Fox, editing by Jackie
Frank)
Sent via BlackBerry by
AT&T

385 total views, no views today

08/02/1999 – SSRI Prescribing in Primary Care Draws Fire

Note that 8% of all general hospital psychiatric admissions caused by
SSRI-induced psychoses!–Thanks to Ann Blake-Tracy for passing this along.
Mark
———–

FromClinical Psychiatry News

SSRI Prescribing in Primary Care Draws Fire

Todd Zwillich, Senior Writer

[Clinical Psychiatry News 27(6):34, 1999. © 1999 International Medical
News
Group.]

————————————————————————
More primary care physicians are prescribing antidepressants, but some
observers worry that patients aren’t being evaluated closely enough for
potential adverse reactions or monitored appropriately while taking the
drugs.

Research is beginning to show that “large numbers” of prescriptions for
selective serotonin reuptake inhibitors (SSRIs) aren’t accompanied by a
diagnosis of depression or any other mental condition, said Stephen
Crystal, Ph.D., a researcher who studies prescribing trends at Rutgers
University in New Brunswick, N.J.

“We have a massive uncontrolled experiment going on out there,” he
said.

The number of doctor office visits including an antidepressant
prescription more than doubled between 1985 and 1994 to more than 24
million, according to data from the National Ambulatory Medical Care
Survey (NAMCS). Researchers attribute the rise to the popularity of
SSRIs.

While an estimated 11 million psychiatrist appointments included an
antidepressant prescription in 1994, more than 10 million other
antidepressant prescriptions were written by primary care doctors.
Preliminary analysis of survey data extending through 1996 shows that
antidepressant prescriptions are now more common in primary care
offices than in psychiatrists’ practices, according to Dr. Crystal.

Managed care is at least partly responsible for the trend. Primary care
physicians acting as gatekeepers in HMOs have been encouraged to treat
potentially depressed patients rather than refer them to specialists.
At the same time, primary care doctors are becoming more comfortable
with the newer SSRIs because they are relatively easy to use.

Toxicity and overdoses are rare, and potential drug interactions are
far less common than with other drug classes. The drugs may also
provide a convenient way to treat somatizing patients who have a few
depressive symptoms without a full-blown depressive episode.

But relatively few data exist to support SSRIs’ efficacy in treating
the “subthreshold” patients often seen in primary care. Many of those
patients may get SSRIs without any official diagnosis, according to Dr.
Harold Pincus, who last year published a study on psychotropic
prescribing using NAMCS data.

Office-based psychiatry practices tend to aggregate around more
affluent and better-educated patients in medium and large cities. Most
observers agree that primary care’s new dominance in antidepressant
prescribing makes the drugs available to a wider range of patients.

“Those who are underserved by specialists are nonwhite and not wealthy.
They are the ones who benefit most from primary care physician
prescribing,” said Dr. Gregory Simon, a psychiatrist who studies
prescribing patterns at Group Health Cooperative of Puget Sound in
Seattle.

The American Psychiatric Association recommends in its depression
treatment guidelines that patients continue their SSRI prescription for
4-5 months after complete remission of their symptoms. But data from
Group Health Cooperative–an HMO that emphasizes primary care treatment
of mental conditions–show that only 34% of patients on SSRIs refill
their prescriptions often enough to suggest continuous use.

At the same time, new data from the Rutgers group show that Medicare
patients treated in primary care are more than twice as likely as
similar patients treated in psychiatric settings to fill their SSRI
prescriptions only once, Dr. Crystal commented.

Others worry that physicians are not paying enough attention to patient
factors that could make initiation of SSRIs dangerous. Dr. Malcolm B.
Bowers Jr., a psychiatrist at Yale University in New Haven, told
CLINICAL PSYCHIATRY NEWS that SSRI-induced psychosis has accounted for
8% of all general hospital psychiatric admissions over a recent
14-month period. [emphasis added]

The pattern suggests that while SSRIs are a help to the majority of
patients who take them, more needs to be done to make sure that doctors
prescribing the drugs evaluate patients for psychotic predispositions
vulnerable to SSRIs. Such patients may include those with a history of
psychotic illness or early signs of mania.

“What is surprising is that this particular group of side effects is
really
underplayed,” Dr. Bowers said.

557 total views, no views today