For fucks sake: antidepressant research methods

I've just been reading something by Robert Whitaker responding to something by a doctor in the new York Times.

What fucking century are we living in? It's been 60 or so years of the double blind randomised control trial as the gold standard of evidence based medicine research.

This is Whitaker's article.
http://www.psychologytoday.com/blog/mad-in-america/201107/the-new-york-times-defense-antidepressants-0

I'vbe just stopped at the end of the first page to have a little rant. I mean...what the fuck?

"
As might be expected, the drug companies in fact design their trials in a manner expected to suppress the placebo response rate. This is done through what is known as a placebo washout period, which may last a few days to two weeks. All patients enrolled into the study -- who may have to be taken off an antidepressant they might have been on -- are given a placebo in single-blind fashion (the investigators know it is a placebo; the patients do not.) Those who get better on placebo in this washout phase are then excluded from the study. Only those who don't respond to a placebo are randomized into the trial. As such, trials with this design might be better described as "drug versus initial non-responders to placebo," and of course this is a design that is supposed to reduce the number of placebo responders in the final results.
"


Placebo washout period which is single blind?

This all sounds like bollocks to me but it's probably stuff I don't understand. I thought the gold standard was the double blind RCT when it should be the triple blind RCT by now.

My assumption is that the trials the FDA uses are trials which are published in peer reviewed journals. I assume the authors of the trials, while being funded by drug dealers...I mean Big Pharma, but the academics are primarily interested in answering a research question. Sloppy methods and stuff might happen but I would guess and hope that the majority of what academics do, apart from be biased, is they desire to protect their academic reputation and pursue the absolute truth through their work.

Their belief in the hypothesis that antidepressants work may influence trial results and interpretation of trial data. This is why the whole triple blind thing is a good idea.

I also assume that academic diagnosis for a trial to be published n a journal is significantly more reliable than what happens in clinical practice. The primary care physicians handing out the drugs don't have the time to make a reference quality diagnosis so all this stuff about the research is bollocks anyway.

It would be interesting to compare a single and double blind trial to see the power of the placebo effect. I would be too biased to interpret the results properly. I think drugs do work. Just the right ones for the right people.

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It also surprises me that the side effects of legal drugs are so bad. Illegal drugs produce a much nicer high with fewer side effects. St john's Wort can produce a nice lift to mood with few side effects. How can the well funded research into chemicals which alter mood be producing such poor drugs when nature has already created good drugs which work for some individuals.
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There's a good point about the problem of research and applying results to clinical practice.

But there is a fundamental problem with the cluster of symptoms approach to diagnosis. It lumps together too many different forms of misery (and psychopathology). The dimensional approach (? if that's the right tmer) or the complaints based apporach might be better, i.e. the patient says "I am mentally unwell" then the doctor asks what is making them unwell and then they try to fix it based on understanding the individual.

Whether any doctors truly have the understanding to be able to do this and also to know that sometimes the pain is worth it...fuck knows when the science will truly get to that level.