Do antidepressants work? [2]

[_Alex_]

My first post on this issue can be found:

healthunlocked.com/mental-h...?

Anyway, here is a recent article on the subject:

"...The latest analysis to form part of this ongoing battle comes from scientists at the Nordic Cochrane Centre in Denmark. This time, the authors conclude that the current level of evidence in support of antidepressants is not sufficient to prove that they work better than placebo.

The review, which now appears in BMJ Open, is a response to a paper by Dr. Andrea Cipriani and team that The Lancet published in February 2018. In the paper, Dr. Cipriani and team compared the performance of 21 antidepressants.

They set out to "compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder," as a guide for doctors.

Their analysis was the largest of its kind; it included 522 trials and 116,477 participants. The researchers concluded that, among other things, "[a]ll antidepressants were more efficacious than placebo in adults with major depressive disorder."

For many, these findings were definitive proof that antidepressants work.

However, "[t]he review received widespread media coverage, largely citing it as finally putting to rest any doubts regarding the efficacy of antidepressants," explain the authors of the latest BMJ Open paper.

Led by Dr. Klaus Monkholm, the authors of the new publication believe that the earlier work by Dr. Cipriani did not address certain biases in the data. Dr. Monkholm and others initially penned a critique in The Lancet in September 2018....

...Although the authors do not claim that antidepressants do not work, they conclude that the evidence is still not strong enough. They call for larger, longer, more rigorous studies. A question as crucial as this is likely to receive ongoing attention."

medicalnewstoday.com/articl...

Also, I previously gave a quote from someone arguing:

"...Every trial on antidepressants uses a scale to measure the severity of depression of subjects before and after the trial. These scales are deeply flawed, and they bias the research toward overestimating the effectiveness of antidepressants...."

I came across someone making the *opposite* argument. That is, they agree that the scales are flawed, but think that the result is actually to bias the research *against* the effectiveness of antidepressants.

Quote:

The recent questioning of the antidepressant effect of selective serotonin reuptake inhibitors (SSRIs) is partly based on the observation that approximately half of company-sponsored trials have failed to reveal a significant difference between active drug and placebo. Most of these have applied the Hamilton depression rating scale to assess symptom severity, the sum score for its 17 items (HDRS-17-sum) serving as effect parameter. In this study, we examined whether the negative outcomes of many SSRI trials may be partly caused by the use of this frequently questioned measure of response. We undertook patient-level post-hoc analyses of 18 industry-sponsored placebo-controlled trials regarding paroxetine, citalopram, sertraline or fluoxetine, and including in total 6669 adults with major depression, the aim being to assess what the outcome would have been if the single item depressed mood (rated 0-4) had been used as a measure of efficacy. In total, 32 drug-placebo comparisons were reassessed. While 18 out of 32 comparisons (56%) failed to separate active drug from placebo at week 6 with respect to reduction in HDRS-17-sum, only 3 out of 32 comparisons (9%) were negative when depressed mood was used as an effect parameter (P<0.001). The observation that 29 out of 32 comparisons detected an antidepressant signal from the tested SSRI suggests the effect of these drugs to be more consistent across trials than previously assumed. Further, the frequent use of the HDRS-17-sum as an effect parameter may have distorted the current view on the usefulness of SSRIs and hampered the development of novel antidepressants.

ncbi.nlm.nih.gov/pubmed/259...