Systemic review of antidepressants vs placebo commentary

michael_b

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/pdf/zfp_222_3_128.pdf

The background on this story is a community of science people found a bunch of unpublished studies that, when weighed with the studies which supported antidepressant approval, showed they were no more effective than placebo in mild-moderate cases.

Except unlike placebo, antidepressants express a wider range of severe side effects, like worsening depression and suicide.

Isn't this a scandal? How do psychiatrists still prescribe these en masse?

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/pdf/zfp_222_3_128.pdf

Except unlike placebo, antidepressants express a wider range of severe side effects, like worsening depression and suicide.

Isn't this a scandal? How do psychiatrists still prescribe these en masse?

This paper includes an interesting paragraph:

And noticing one of the listed side effects, would you not conclude that you had been given the real drug? In one study, 89% of the patients in the drug group correctly ‘‘guessed’’ that they had been given the real antidepressant, a result that is very unlikely to be due to chance

If that's true shouldn't we ask this question by default in placebo-blind trials?

Probably but the use and interpretation of blinding indexes is still a bit controversial. For example, the 2001 CONSORT guidelines suggested using and reporting a blinding index but the latest 2010 version dropped it, saying:

Item 11 (blinding)—We added the specification of how blinding was done and, if relevant, a description of the similarity of interventions and procedures. We also eliminated text on “how the success of blinding (masking) was assessed” because of a lack of empirical evidence supporting the practice, as well as theoretical concerns abou

... (read more)

0OrphanWilde11y

The absence of the percentage of people on placebos who guessed that they had been given the real antidepressants suggests cherry-picking. Cherry-picking suggests the entire article is garbage. Unfortunately the article they cite is behind a paywall, but the abstract includes this: "We studied medication guesses of 137 depressed patients and/or their doctors at the end of a 6-week randomized trial of placebo, imipramine, and phenelzine. Overall, 78% of the patients and 87% of the doctors correctly distinguished between placebo and active medication" Assuming 1/3 were assigned to each group, and the majority of each group guessed they were on medications, the patient percentages are pretty close to what you'd expect anyways.