Our Letter to NEJM on Cognitive Behavioral Therapy and Zoloft for Childhood Anxiety Disorders Published

4 Responses to Our Letter to NEJM on Cognitive Behavioral Therapy and Zoloft for Childhood Anxiety Disorders Published

1. Dan says:

   August 11, 2009 at 1:56 pm

   As far as I know, Zoloft is not indicated, nor has ever showed any benfit, fictional or otherwise, for GAD or separation disorder.

   Also, with the results including the vague term, ‘improved’, kinda reminds me of two things.

   Buying, say, new toothpaste that is ‘new and improved’

   And also the fact that disorders labeled social phobia, for example, may not be disorders in the first place (zoloft historically has shown only modest improvement with social phobia).

   So how can others study the benefits for treating a disorder that may not exist, and then measure such benefits? Do others measure subjective diagnoses with subjective results? It’s possible.
2. JBZ says:

   August 12, 2009 at 5:35 am

   I think it is valid to criticize the use of the (categorical) clinical global impression-improvement scale instead of the (continuous)PARS as the main instrument to report differences between CBT and SSRI+CBT outcome. I found the response of the authors on your comment unsatisfactionairy.
   In their response to comments by Rifkin and Braga, Walkup et al also failed to convince me. Rifkin and Braga address that
   “There was no treatment group in which cognitive behavioural therapy plus placebo was used. The absence of such a group prevented the investigators from determining whether the addition of sertraline to cognitive behavioural therapy resulted in more improvement than each treatment given separately because of an additive effect of two active treatments or because of the placebo effect of adding a pill to cognitive behavioural therapy.”
   R and B go on that the combination group was not blinded in contrast with the SSRI and placebo group. These are very important point’s imo. Walkup at al replies:
   “We chose the four-group design primarily for reasons of ecologic validity”.
   That may be true for the two by two design but rejecting the one by five design (the one with the CBT+placebo) for ecologic validity reasons is just plain ignorant and false. Walkup continues:
   “The one by five design was rejected as unfeasible. To detect the smallest, clinically meaningful difference in the response rate(10%) between cognitive behavioural therapy plus sertraline and cognitive behavioural therapy plus placebo would have required a substantial increase in the sample size and study duration.”
   No shit Sherlock… That’s the whole point. There is probably no difference between the CBT+SSRI and the CBT+placebo group and if there’s a difference it will be very small. So why than take al the risks of side affects and extra costs of adding a SSRI to CBT?
   Final point about the physician you quoted in our article “Effects of Zoloft on Childhood Anxiety Incredible, Indeed” of jan 25, who said that the results of the study where incredible. He is seriously degrading his academic credibility with remarks like that in this context!
3. dougbremner says:

   August 12, 2009 at 9:18 am

   good comment. so in sum the recommendation to use cmbo therapy based on these study results is bogus.
4. Amy Philo says:

   August 19, 2009 at 7:39 pm

   Thanks for explaining how they manage to fudge the info with misleading graphs and statistics. I have seen things like this before, it’s not surprising. You rock.