{"id":20971,"date":"2012-03-12T21:41:25","date_gmt":"2012-03-13T02:41:25","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=20971"},"modified":"2012-03-14T10:33:24","modified_gmt":"2012-03-14T15:33:24","slug":"more-clearly-iii","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/03\/12\/more-clearly-iii\/","title":{"rendered":"more clearly III…"},"content":{"rendered":"
I ended my last post by saying I’d "go<\/em> rest a while" – but it wasn’t as restful as I’d planned. Ever since the second Gibbons article came out [Benefits From Antidepressants<\/font><\/a><\/strong><\/u>], I’ve had a nagging doubt about the outcome, particularly in children. The reported response rates and remission rates just seem too good to me compared to the studies he used for his analysis. At a time when the efficacy of SSRIs is being heavily criticized, he says:<\/div>\n
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The results do not support previous findings that antidepressants show little benefit except for severe depression. The antidepressants fluoxetine and venlafaxine are efficacious for major depressive disorder in all age groups, although more so in youths and adults compared with geriatric patients. Baseline severity was not significantly related to degree of treatment advantage over placebo.<\/sup><\/div>\n<\/blockquote>\n
As mentioned last time, they didn’t even look at the venlafaxine studies in kids [more clearly II…<\/font><\/strong><\/u>]<\/a>, so that "fluoxetine and venlafaxine are efficacious for major depressive disorder in all age groups" comment is out of line, but even the fluoxetine results seem overly optimistic to me.<\/div>\n

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Obviously, I can’t reproduce their calculations since their datasets are not available and their methodology is dense and beyond my knowledge or resources, but what I could do is look at the ways the original studies reported their results. There are many ways people regularly report outcomes: the mean changes in a variable; the % responding based on some criteria; the % remitting based on some criteria; the Number Needed to Treat, a number derived from comparing placebo and treatment responses. NNT means, "How many patients would I have to treat to beat the placebo results?" Obviously, the lower the NNT, the greater the efficacy. Looking at Gibbons’ study, the change in CDRS-R score was not computed but rather expressed as complex regression trajectories requiring full data [as they say, "beyond the scope…"]. But he did report % responding<\/em>, % remitting<\/em>, and the NNT<\/em> values in the more usual ways:<\/div>\n