Prescribing Supplements and Vitamins

[watto]

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COME ON!!! Equivalent response between active placebo control and test drug, and conclusion is wow, they both work great, let's recommend for patient care?? Really, the scientific thinking on this one left a lot to be desired. How is it still being bandied about.

If you feel good about the clinical response you've seen on with caffeine that's great (personally I haven't been impressed), but this particular study should be buried.

I'd say the jury is out on a lot of caffeine studies, given more recent research on genetic nonresponders that are out there. Explains the subset of patients (and colleagues) I have who down Starbucks at night and have no problems conking out:

Genetics of caffeine consumption and responses to caffeine - PMC

Caffeine is widely consumed in foods and beverages and is also used for a variety of medical purposes. Despite its widespread use, relatively little is understood regarding how genetics affects consumption, acute response, or the long-term effects ...

www.ncbi.nlm.nih.gov

 

[clozareal]

COME ON!!! Equivalent response between active placebo control and test drug, and conclusion is wow, they both work great, let's recommend for patient care?? Really, the scientific thinking on this one left a lot to be desired. How is it still being bandied about.

If you feel good about the clinical response you've seen on with caffeine that's great (personally I haven't been impressed), but this particular study should be buried.

The study I linked to did not compare the test drug against an active placebo. They used dextroamphetamine because it had positive results compared to placebo in two older small RCTs. One of them was Tom Insel's earlier work. I have no clue why they didn't just compare high-dose caffeine against placebo like this study did, which statistically significant positive result (albeit questionable whether it is clinically significant of a response).

It's definitely not my 1st through 6th line of augmentation agent of choice for OCD. However, the options for supplements and vitamins are pretty limited for OCD.

I've never made a claim that this study is of the highest quality for caffeine nor do I make that claim for any of the other supplements I mentioned. Most of the vitamin/supplement studies are of lower quality with lots of unadjusted confounders, let alone RCT data. Also, I typically am cautious about the conflicts of interest with Journal of Clinical Psychiatry because it's industry-sponsored, so it's a bit unusual for them to publish a paper on a cheap generic supplement.

 

[tr]

The study I linked to did not compare the test drug against an active placebo. They used dextroamphetamine because it had positive results compared to placebo in two older small RCTs. One of them was Tom Insel's earlier work. I have no clue why they didn't just compare high-dose caffeine against placebo like this study did, which statistically significant positive result (albeit questionable whether it is clinically significant of a response).

Because the caffeine was intended to be the active placebo, not the study drug. They were looking for an effect of amphetamine, trying to control for nonspecific activation/arousal effects by using caffeine (active placebo) instead of sugar pill (inactive placebo). The results, showing equivalent improvements in both trial arms, are impossible to interpret - could mean the nonspecific arousal is helpful, could also mean the treatment environment (or something else) is helpful and the drugs are irrelevant. Impossible to tell from this study design, but holding it up as a fortuitous discovery of the specific benefits of caffeine for OCD is really not justified.

This is why you're now supposed to declare your endpoints up front and stick to them.