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What does the latest meta-analysis really tell us about antidepressants?

  • J. Moncrieff (a1)

Abstract

A recent meta-analysis of antidepressant trials is the largest conducted to date. Although it claims to prove antidepressant effectiveness beyond dispute, the main outcome is response rates, which are derived from continuous data in a process that can inflate differences between groups. The standardised mean difference of 0.3 is in line with other meta-analyses that show small differences between antidepressants and placebo that are unlikely to be clinically significant. Other factors likely to exaggerate the effects are discussed, and evidence on associations between antidepressant effects and severity and outcomes of long-term treatment is considered. Clinicians need to have open discussions with patients about the limitations of antidepressant research, the lack of evidence that antidepressants correct a chemical imbalance or other brain abnormality, and the range of adverse effects and mental and physical alterations they can produce.

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Copyright

Corresponding author

*Address for correspondence: J. Moncrieff, Division of Psychiatry, University College London, London, UK. (Email: j.moncrieff@ucl.ac.uk)

References

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Boseley, S (2018). The drugs do work: antidepressants are effective study shows. The Guardian, 21-2-2018.
Cipriani, A, Furukawa, TA, Salanti, G, Chaimani, A, Atkinson, LZ, Ogawa, Y, Leucht, S, Ruhe, HG, Turner, EH, Higgins, JPT, Egger, M, Takeshima, N, Hayasaka, Y, Imai, H, Shinohara, K, Tajika, A, Ioannidis, JPA, Geddes, JR (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet 391, 13571366.
Farnsworth, KD, Dinsmore, WW (2009). Persistent sexual dysfunction in genitourinary medicine clinic attendees induced by selective serotonin reuptake inhibitors. International Journal of STD and AIDS 20, 6869.
Gibbons, RD, Hur, K, Brown, CH, Davis, JM, Mann, JJ (2012). Benefits from antidepressants: synthesis of 6-week patient-level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine. Archives General Psychiatry 69, 572579.
Kirsch, I, Moncrieff, J (2007). Clinical trials and the response rate illusion. Contemporary Clinical Trials 28, 348351.
Kirsch, I, Moore, TJ, Scoboria, A, Nicholls, SS (2002). The emperor's new drugs: an analysis of antidepressant medication data submitted to the US Food and Drug Administration. Prevention and Treatment 5, 23.
Kirsch, I, Deacon, BJ, Huedo-Medina, TB, Scoboria, A, Moore, TJ, Johnson, BT (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine 5, e45.
Moncrieff, J, Kirsch, I (2015). Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences. Contempemporary Clinical Trials 43, 6062.
Pigott, HE, Leventhal, AM, Alter, GS, Boren, JJ (2010). Efficacy and effectiveness of antidepressants: current status of research. Psychotherapy and Psychosomatics 79, 267279.
Sharma, T, Guski, LS, Freund, N, Gotzsche, PC (2016). Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. Brisith Medical Journal 352, i65.
Sinyor, M, Levitt, AJ, Cheung, AH, Schaffer, A, Kiss, A, Dowlati, Y, Lanctot, KL (2010). Does inclusion of a placebo arm influence response to active antidepressant treatment in randomized controlled trials? Results from pooled and meta-analyses. Journal of Clinical Psychiatry 71, 270279.
Walsh, BT, Seidman, SN, Sysko, R, Gould, M (2002). Placebo response in studies of major depression: variable, substantial, and growing. Journal of the American Medical Association 287, 18401847.

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