Posted by SLS on January 28, 2009, at 18:29:53
In reply to Re: Stats...ooops » SLS, posted by Larry Hoover on January 28, 2009, at 10:20:17
What are we treating?
It has been a contention of mine that the inclusion criteria for antidepressant trials is too broad - that is, if one is testing the efficacy of drugs to treat Major Depressive Disorder. I feel that too many studies allow for psychogenic or situational depressions to get through - mostly with "mild-to-moderate" depressions. Limiting inclusions to people with depression scores in the severe range promotes a greater likelihood that one is looking at true MDD. In such studies, active compound separates from placebo by a very large margin. It is quite convincing.
This is not to say that MDD does not include mild to moderate presentations. It does. They just get lost in the pool of non-biological depressions. I believe that non-biological depressions are much more apt to respond to placebo than biological depressions, especially with the extra care, attention, promise, and hope that is presented to them in a clinical trial.
Without greater diagnostic specificity, biomarkers would be the only way to separate out Major Depressive Disorder from other types. So... until then, selecting the more severe cases increases the percentage of biological depressions being tested.
There. I said it.
I'm ready for the wet noodle.
Oh, before I forget. Crap. I forgot.
Oh, well. It will come to me. Maybe next time.
Oh, yeah. I bet if clinical trials were allowed to run for more than 6 weeks, many of your placebo responders would "relapse", thereby separating active compound from placebo by a larger margin at the completion of the study.
I have no statistical background, so I must rely on intuition. Lame, I know. I understand much of what you explain, but without having the tools myself, I cannot analyze things from the same perspective on my own. Thanks for all your help.
- Scott
poster:SLS
thread:876214
URL: http://www.dr-bob.org/babble/20090104/msgs/876870.html