A very interesting read. I didn’t know much about BSD.
I was wondering if you had a spreadsheet or something equivalent where you put all the numbers you mention together? Prevalence, loss due to misdiagnoses, false positives, costs, etc. It could help with understanding the predicted cost-effectiveness of the different actions you mention. Apologies if I missed it in the core text.
Here is the spreadsheet. I would like to add error margins and more detailed epistemic status analysis at some point. The main variables affecting the cost effectivenes and somewhat uncertain are:
Effectiveness of treatment—I chose to assume that getting a correct diagnosis and treatment with lamotrigine leads to recovery of 10% of patients, compared to being treated with SSRIs. This is just a guesstimate based on the best evidence available, which is still insufficient. Perhaps the first step to the success of this intervention would be gathering more evidence in support of lamotrigine, but the cost involved may render it no longer cost-effective.
Percentage of patients with BSD among those seeking primary care treatment for depression (or, in a variant of the intervention, among patients who failed to recover on their first SSRI). The data exists for patients hospitalised for a major depressive episode (27%), and for patients referred to a psychiatrist for mood disorders (36%), but these numbers may be larger than what we need. On the other hand, it is roughly consistent with the 5% 12-month prevalence of depression and 2% prevalence of BSD.
Thank you! I have some more detailed notes on the calculations I made, and the resulting numbers are in the post, but creating a proper spreadsheet with it is a good idea! I’ll do it on Monday (edit: Tuesday-Wednesday, life’s too busy!) and update the post.
A very interesting read. I didn’t know much about BSD.
I was wondering if you had a spreadsheet or something equivalent where you put all the numbers you mention together? Prevalence, loss due to misdiagnoses, false positives, costs, etc. It could help with understanding the predicted cost-effectiveness of the different actions you mention. Apologies if I missed it in the core text.
Here is the spreadsheet. I would like to add error margins and more detailed epistemic status analysis at some point. The main variables affecting the cost effectivenes and somewhat uncertain are:
Effectiveness of treatment—I chose to assume that getting a correct diagnosis and treatment with lamotrigine leads to recovery of 10% of patients, compared to being treated with SSRIs. This is just a guesstimate based on the best evidence available, which is still insufficient. Perhaps the first step to the success of this intervention would be gathering more evidence in support of lamotrigine, but the cost involved may render it no longer cost-effective.
Percentage of patients with BSD among those seeking primary care treatment for depression (or, in a variant of the intervention, among patients who failed to recover on their first SSRI). The data exists for patients hospitalised for a major depressive episode (27%), and for patients referred to a psychiatrist for mood disorders (36%), but these numbers may be larger than what we need. On the other hand, it is roughly consistent with the 5% 12-month prevalence of depression and 2% prevalence of BSD.
Thank you! I have some more detailed notes on the calculations I made, and the resulting numbers are in the post, but creating a proper spreadsheet with it is a good idea! I’ll do it on Monday (edit: Tuesday-Wednesday, life’s too busy!) and update the post.