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Title: Statistically significant antidepressant-placebo differences on subjective symptom-rating scales do not prove that the drugs work : effect Size and method bias matter!
Authors : Hengartner, Michael P.
Plöderl, Martin
Published in : Frontiers in Psychiatry
Volume(Issue) : 9
Issue : 517
Publisher / Ed. Institution : Frontiers Research Foundation
Issue Date: 2018
License (according to publishing contract) : Licence according to publishing contract
Type of review: Open peer review
Language : English
Subject (DDC) : 616.8: Neurology, diseases of nervous system
Abstract: Following the publication of a recent meta-analysis by Cipriani et al., various opinion leaders and news reports claimed that the effectiveness of antidepressants has been definitely proven. E.g., Dr. Pariante, spokesperson for the Royal College of Psychiatrists, stated that this study “finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression” ( We surely would embrace drug treatments that effectively help most people with depression, but based on work that has contested the validity of mostly industry-sponsored antidepressant trials we remain skeptical about antidepressants' clinical benefits. The most recent meta-analysis indeed concludes that antidepressants are more effective than placebo but also acknowledges that risk of bias was substantial and that the mean effect size of d = 0.3 was modest. Unfortunately, no clarification is given what this effect size means and whether it can be expected to be clinically significant in real-world routine practice. In this opinion paper we therefore ponder over how the reported effect size of d = 0.3 relates to clinical significance and how method bias undermines its validity, in order that the public, clinicians, and patients can judge for themselves whether antidepressants clearly work in most people with depression.
Departement: Applied Psychology
Organisational Unit: Psychological Institute (PI)
Publication type: Article in scientific journal
DOI : 10.21256/zhaw-4760
ISSN: 1664-0640
Appears in Collections:Publikationen Angewandte Psychologie

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