Physician: "all anti-depressants are basically the same."

Factual Questions
21

Absence of a placebo group is a serious flaw, and your reasoning is contradicted by many studies. I am often amazed at the sloppy and misleading studies that prominent journals will publish. I think most medical practitioners don’t have enough training in experimental psychology to really understand what they are reading. I offer you a brief sample below. I know, I would be the patient from hell, walking into my doctor’s office with an armload of studies to carefully explain how their impressions of the research are quite wrong.

Consider this study (JAMA. 2002 Apr 10;287(14):1853-4.) which says on one hand:
“On the 2 primary outcome measures, neither sertraline nor H perforatum was significantly different from placebo”
BUT concludes that:
*“This study fails to support the efficacy of H perforatum in moderately severe major depression.” *True, but since sertraline was also shown to be ineffective, there is something very wrong with their study.

Consider this quote “In the eight-week, double-blind, randomized comparison of hypericum to placebo and sertraline, 31.9% of patients responded fully to placebo, compared to 24.8% responding to sertraline and 23.9% to hypericum (HDTSG, 2002).” In other words, placebo worked better than sertraline!

“…JAMA writes an editorial pointing out that such studies are showing no drug effect at all – that any apparent drug effect is really just placebo.”
http://groups.yahoo.com/group/biofeedback/message/9946

And further

Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication
Irving Kirsch, Ph.D.,Guy Sapirstein, Ph.D.
Westwood Lodge Hospital, Needham, MA

Prevention & Treatment, Volume 1, Article 0002a, posted June 26, 1998
ABSTRACT
Mean effect sizes for changes in depression were calculated for 2,318 patients who had been randomly assigned to either antidepressant medication or placebo in 19 double-blind clinical trials. As a proportion of the drug response, the placebo response was constant across different types of medication (75%), and the correlation between placebo effect and drug effect was .90. These data indicate that virtually all of the variation in drug effect size was due to the placebo characteristics of the studies. The effect size for active medications that are not regarded to be antidepressants was as large as that for those classified as antidepressants, and in both cases, the inactive placebos produced improvement that was 75% of the effect of the active drug. These data raise
the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect. Examination of pre-post effect sizes among depressed individuals assigned to no-treatment or wait-list control groups suggest that approximately one quarter of the drug response is due to the administration of an active medication, one half is a placebo effect,
and the remaining quarter is due to other nonspecific factors.

22

The issue of including a placebo arm in clinical trials is a thorny one and I do not profess to be an expert in the area.

However, once a treatment has been demonstrated to be superior to placebo for a given condition, it is unethical to include placebo arms in any further therapeutic trials for that condition. One must compare new treatments with established ones, not with placebo.

In the specific instances of the three SSRI’s used in the trial I cited, each had been shown previously to be superior to placebo.

Indeed, clinical medicine is full of non-placebo controlled trials when a standard of therapy, or effective therapy, already exists. The SSRI study above was just another.

23

Insofar as it is all animal muscle fibre, all meats are the same, too, but I’d rather have steak at Smith and Wollensky’s than Norwegian Rat from the rat trap in our kitchen.

Certainly there are similarities among antidepressants, and I have some misgivings about all of them, but the doctor’s statement in the OP is a damn stupid thing to say.

Get another doctor.