Do antidepressants work? Jacob Stegenga

[Cheshire]

Some interresting considerations about trials methodology (CoI, selectivity in publishing trials with positive results, gap between patients selected and real life patients, scales, what is used as a placebo...)

The problem with this scale is that large changes in a subject’s score can occur as a result of trivial changes in a subject’s real depression. For example, there are three questions about the quality of a subject’s sleep, with a total of six possible points, and there is a question about how much a subject is fidgeting, with up to four points. So a drug that simply made people sleep better and fidget less could lower one’s depression score by 10 points. To put this in context, recent clinical guidelines in the UK have required drugs to lower depression scores on this scale by an average of only three points. When a measurement scale measures what we want it to measure, we say the scale has ‘construct validity’. The general problem with depression-severity scales is that they lack construct validity, and this contributes to overestimating the effectiveness of antidepressants.

Rings a bell?

https://aeon.co/essays/the-evidence...G0isq49Qtq5PIFtBnRSR-xeJJSIwggXT7VuswjGUZgBqY

 

[Alvin]

A construct on a subjective construct is not on solid ground.

 

[hellytheelephant]

In answer to the title of this thread: for me-yes.
I have to say for many people they are literally life-saving. In terms of ME, not a jot of difference.

 

[ME/CFS Skeptic]

I see that the author, Jacob Stegenga, has also written a book that looks interesting: Medical Nihilism. From the blurb:

This book argues that if we consider the ubiquity of small effect sizes in medicine, the extent of misleading evidence in medical research, the thin theoretical basis of many interventions, and the malleability of empirical methods, and if we employ our best inductive framework, then our confidence in medical interventions ought to be low.

 

[obeat]

I see that the author, Jacob Stegenga, has also written a book that looks interesting: Medical Nihilism. From the blurb:

Spot on. I don't want the medical profession developing any other interventions until they know what this illness is.

 

[Cheshire]

Anti-depressants do work: reply to Stegenga

Bearing this in mind, let us turn to Stegenga's basic argument that "we simply have no good evidence that antidepressants help sufferers to improve." He contends, first, that "the best evidence about the effectiveness of antidepressants comes from randomised trials and meta-analyses of these trials." I will explain below why--on methodological grounds--I believe this to be false. Stegenga's argument then is that in randomized trials and meta-analyses, observed mean effect sizes are tiny:

In meta-analyses that include as much of the evidence as possible, the severity of depression among subjects who receive antidepressants goes down by approximately two points compared with subjects who receive a placebo. Two points...We saw above how clinical guidelines have held that drugs must lower severity-depression scores by three points to be deemed effective. On this standard, antidepressants do not pass.

So that's the argument:

1. Randomized trials and meta-analyses are the best evidence for efficacy of anti-depressants.
2. Randomized trials and meta-analysis indicate tiny mean effect-sizes for anti-depressants.
3. If (1) and (2) are true, then we have no good evidence that anti-depressants help sufferers to improve.
4. Thus (from 1-3), we have no good evidence that anti-depressants help sufferers to improve.

Here's the problem: (1) in this argument is arguably false, as is premise (3). Let me begin with (1).

https://philosopherscocoon.typepad.com/blog/2019/03/anti-depressants-do-work-reply-to-stegenga.html