Dear FS,

There is much to look at in this study. It would be great to know the actual NUMBER of CBT sessions completed by 1 - those IN the CBT group, and 2- those NOT in the CBT group. What happened in other studies like this... is that the DOSAGE of CBT was SO sub par, that they had to make a variable.. adequacy of treatment. Also in MY trial, the CONTROL group, took themselves to therapy too, like about 20 percent of them. This is the life of effectiveness rather than efficacy trials.

So basically, they hid the fact that most participants get far fewer than the required number of session.. oh yes, to game that even further, they start to have the "therapists" (note who actually DID the CBT, versus who SUPERVISED the CBT)CALL up those who didn't complete the CBT TX, and try to talk to them... those are now added to the "therapy sessions." In the last BIG trial I worked on (similar to STAR), this is what they did. Also, if you look at the Celexa group carefully, HOW much meds, DID THE PEOPLE ACTUALLY TAKE.. IN comparison to what they were SUPPOSED to take. This is what the statisticians like myself see. Do they use the client's report of how much drug taken... or the amount they dosed... it might be hard to tell :)

In my trial, the meds were not efficacious and the therapy was. Thats because it was supervised by the woman who essentially is MS. CBT.

Lastly, you mentioned this, and I am going to reinforce this: THESE STUDIES ARE NOT POWERED TO DO HEAD ON COMPARISONS, more likely to compare to treatment as usual.

Thanks, FS, for ANOTHER great posting. I look forward to hearing more from you, when you get time.

Love and Peace,

Dr. BK

?

"Cognitive therapy produced remission more slowly than medication, but it produced fewer side effects."

CT produces side effects? That's a first.

This may sound odd--but some people may not have the patience to stick with Cognitive Therapy. It takes time, and a lot of determination to "get into" something such as CT or DBT. In a way, the success rate could be higher w/ the Celexa, because when people in general want to feel better--and start a med with the belief the med will make things "better"; it could be in fact that the person was believing in feeling better enough, that it appeared it was the Celexa.

Here's the part that I thought was something people should take note of: "Cognitive therapy produced remission more slowly than medication, but it produced fewer side effects."

I think I would rather have a slow process of remission that leaves me with coping skills, rather than a quick fix med w/ side effects.But that's just my opinion.

Unless you know whether those dudes getting the CT alone were in withdrawal (i.e. what is their prior history of being medicated?) the comparison won't mean a whole heck of a lot. All these studies usually allow some ridiculously short "wash-out" period that's meaningless -- it's pretty hard to find people for these trials that are drug naive, thus invalidating the comparisons. If they were put in CT alone after the Celexa treatment failed then that's a huge red flag that they were in withdrawal. Professionals vastly underestimate the time it takes to recover from a course of treatment with antidepressants or any other psych drug for that matter and love to make you believe it's really your disease that's giving you all that trouble when it's nothing of the sort.

Yes, more please. How very disappointing.
Best wishes

There are so many things I would want to know before drawing any conclusions. Maybe therapy wasn't that effective because the therapists used in the study sucked. Not all therapists are skilled at what they do.