Unfortunately your only options are to file a FOIA request with the FDA or else rely on clinicaltrials.gov. Neither are great options for various reasons. But there have been a bunch of studies that compare all clinical trials with all published trials, and the results are pretty shocking. E.g. the reason why many people mistakenly believe that SSRIs are effective for moderate and severe depression (as opposed to not effective for any type of depression) is because the study that found that made the mistake of relying only on published research. (Which the authors of that study apparently acknowledged later on.)
In Irvin Kirsch's book The Emperor's New Drugs he goes over this at length.
> the reason why many people mistakenly believe that SSRIs are effective for moderate and severe depression (as opposed to not effective for any type of depression)
I'm taking an SSRI now, after about ten years off, and have taken them on and off for more than two decades, and they most definitely have a dramatic effect on anxiety and depression - the effects and general mechanism are pretty obvious. Basically, emotional reactivity is reduced as well as the tendency to ruminate. For me, this effect is clear as day, as are why it causes the side effects that it does which is why I typically don't stay on them for very long. While they don't work for everyone, SSRIs have been enormously popular for at least two decades.
So I gather that you believe the entirety of SSRI's popularity, as well as all the good/bad physiological effects many of us taking them find so apparent, are strictly placebo effect?
To paraphrase: "I'm taking SSRIs right now, and they work for me."
That's the medical equivalent of saying, "it works on my machine." That doesn't mean it works for everyone. It doesn't mean that it works for most people, or that there isn't a significant risk of harm to many people. Hell, your perception that it works for you doesn't even mean that it actually works for you (there could be confounding factors for all we know), and it certainly doesn't mean that it's likely to work better than the next-best alternative.
Think about it: If somebody says SSRIs are incorrectly believed to be effective due to publication bias, that pretty much presupposes that there's at least one study that showed that they work. That means that somebody, somewhere had a similar experience as you've had. That doesn't make your experience a sufficient basis for prescribing these drugs on a routine basis.
Clinical trials are like beta tests. The drug might work for some people (or some people might feel that it works), but that's not the only thing worth considering before you ship it to large numbers of people who need treatment.
I'm well aware of the "they work for me, therefore they work" fallacy. I also never said they work for everyone or even most people.
The fact is there's both positive and negative studies of SSRIs, the debate over their effectiveness remains ongoing, and at the moment these medications are widely accepted and used. Real world experience of these medications among a huge number of practitioners and patients is still ahead of this debate, in my opinion.
"So I gather that you believe the entirety of SSRI's popularity, as well as all the good/bad physiological effects many of us taking them find so apparent, are strictly placebo effect?"
When you say "I gather that you believe" you seem to be implying that it's an opinion question. But for what it's worth, that's not how it works exactly. Again read The Emperors New Drugs for a good explanation. The book Anatomy of an Epidemic also has some good info in the relevant chapter.
Going on your statement, "not effective for any type of depression", you're saying that the SSRI I'm taking has no effect whatsoever, and that nobody else has any benefits from SSRIs. The good effects we all report are imagined. I'd just like you to directly confirm that's what you're saying. It's a little rude to state that I'm completely misguided in my healthcare choices, then to wave it off as "just go read this book" when i question that.
It's incorrect to say that grandparent's quote "not effective" is the same as your phrase "no effect whatsoever."
The suggestion, following Irving Kirsch's book, that the SSRIs are broadly "not effective," is a statement about the distribution of outcomes over a population. (It also takes into account the fact that even placebos cause changes in outcomes, and that we consider a drug not to be "effective" if its outcomes do not differ meaningfully from those attributable to placebos.) This is maybe better stated as "not efficacious" because we're talking about efficacy, vs. placebo, in a population.
This is entirely different from the parent's (counterfactual) statement "the SSRI I'm taking has no effect whatsoever," which is an assertion about having any effect (not a relative effect vs. placebo) in a single individual (not a population).
"Not effective"[as a vector operation and vs. a baseline established by placebo] != "has no effect whatsoever"[as a scalar operation and vs. a baseline of no intervention]
Grandparent has most definitely not said that your perception of SSRI effects are "imagined," nor that you are "misguided." But you are arguing against a straw man until you at least acknowledge the distinctions here (which, it must be said, are pretty well explained in the book in question ;)
Thanks for the language litigation, I'm now aware of the many subtle inaccuracies in my language, despite my skepticism that my real question was really so occluded. So here it is again:
Is it your opinion that the popularity of SSRIs is misguided, and that their use would be better off discouraged, since they have been shown to be no more "effective" than placebo? That the vast majority of (or all?) patients who report "success" with SSRIs are simply experiencing an effect that could just as easily be delivered via sugar pill?
Wikipedia's paragraph on this here (http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_in...) has a decent summary of the current status. SSRIs have been shown, by two meta-analyses, to have a "clinically significant" effect for very severe depression, and a "statistically significant" effect for moderate depression, which is considered below the threshold of usefulness. The original poster's words were, "not effective for any type of depression". So will you correct this statement as well?
Again, you need to read the book(s) if you want to understand the argument. The Wiki paragraph doesn't actually do a good job explaining much of anything.
nevermind, I've reviewed enough of Kirsch's book and discussion of it at this point to see that it is virulently opposed to antidepressants and is cited broadly by various career opponents of psychiatry as well as a large number of lay-people troubled by the concept of depression as a medical illness. And as one would expect, often challenged by actual psychiatrists (but not always), focusing mostly on the inherently flawed state of measurement with regards to depression.
Particularly troubling is the lack of critical analysis that can be found regarding Kirsch's book. Googling for it reveals tons of links from various magazines and news sites with sensationalistic headlines, feeding into an emotion that is easy to tap, which is the discomfort many people have with the entire concept of antidepressants. "Going on antidepressants? Read this first!" that kind of thing.
As for a formally written challenge to Kirsch, I could only find this times editorial http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepre... which makes the argument that someone in my position has already suspected, that the studies being cited are flawed - that it is exceedingly difficult to identify bona-fide "mildly or moderately depressed" people to participate in a study, not to mention that measuring depression is a completely subjective affair:
> Often subjects who don’t really have depression are included — and (no surprise) weeks down the road they are not depressed. People may exaggerate their symptoms to get free care or incentive payments offered in trials. Other, perfectly honest subjects participate when they are at their worst and then spontaneously return to their usual, lower, level of depression.
Without an objective means of measuring depression, measuring the effect of drugs objectively is not straightforward.
Kirsch has, like everyone else, approached this study with a definite bias, a career based on raising the prominence of the placebo affect. I'm not sure you can read a few books and declare "the truth" as case closed here, all ideas are subject to challenge. In this case I think there's a lack of interest in challenging this idea as the drug companies are obviously doing quite well (and I am no fan of drug companies) and probably don't want to raise more attention to it. It's an extraordinary claim that the millions of people who insist that SSRIs are very effective for them are being deceived en-masse, and one under-critiqued meta-study might not be enough to prove that claim.
Interesting comment on that article as well:
> "Papers showing that antidepressants work had found their way into print; unfavorable findings had not." The point is, that there are any number of ways a clinical trial can be run such that an "effective" drug will not be able to demonstrate a level of statistical significance. While there is no way you can run a clinical trial so that an "ineffective" drug will demonstrate a level of statistical significance. If you run nine clinical trials that fail to show a drug is active, and one clinical trial that shows that it is active; when presented with this kind of data, most people in the general public would wrongly conclude that the drug is not active. In fact, the correct conclusion is that the drug is active. That is why it is the job of qualified experts at the FDA, and not the public, to examine the information generated from clinical trials and pass judgment as to whether or not a drug has been proved to be "safe and effective".
If it were possible to make an ineffective drug demonstrate a level of statistical significance, then we'd have tons of studies proving the efficacy of homeopathy, wouldn't we ?
OK....what do you look at then ?