Insomnia Forum Posting

Posted by ronnie on July 17, 2002 at 16:25:45:

In Reply to: Re: Re: Remeron/Zoloft combination posted by Downtown on July 17, 2002 at 12:30:06:

There are many studies that do show that antidepressants are more effective than placebo, and also many studies that show that SSRI's are as effective as the older antidepressants, although there are substantial placebo effects in many of these studies.

Clinical trial populations tend to be recruited from populations which have moderate rather than severe depression. Many researchers consider it to be unethical for people with severe depression to have only a 50% chance of receiving the drug, so don't include them in initial studies. Also people with severe depression might not sign up for a clinical trial with a placebo in that there is a 50% chance they won't get any medication.

So the trouble with clinical trials involving antidepressants is that the population who is involved in them is less sick than those who really need the medication, and that may partially account for the reason why result differences are not as dramatic as one might expect.

Also, most clinical trials are given for very short amounts of time: 6-8 weeks. This differs dramatically from the amount of time people are actually on these medications: 6 months to years.

On the second point, I agree that distiguishing symptoms that occur when quitting a med from the reemergence of depression is a great difficulty, because only that individual knows what they felt like with that symptom when they had depression and can determine whether they have the same symptom or a different one.

Perhaps insomnia from meds "feels different" to people than insomnia from depression- I think it does, and has different characteristics...

...but the tables included in the clinical trials just list "insomnia" as one big category of side-effect, which is not very helpful when you can't sleep!

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