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Munkholm Munkholm, 2019, Considering the methodological limitations in the evidence base of antidepressants for depression: a reanalysis of a network meta-analysis

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Linus

BMJ Open 2019;9:e024886

 

Considering the methodological limitations in the evidence base of antidepressants for depression: a reanalysis of a network meta-analysis

 

Klaus Munkholm, Asger Sand Paludan-Müller, Kim Boesen (Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark

 

Source: BMJ Open

 

Full text is available here : https://bmjopen.bmj.com/content/9/6/e024886

 

Objectives : To investigate whether the conclusion of a recent systematic review and network meta-analysis (Cipriani et al) that antidepressants are more efficacious than placebo for adult depression was supported by the evidence.

 

Conclusions : The evidence does not support definitive conclusions regarding the benefits of antidepressants for depression in adults. It is unclear whether antidepressants are more efficacious than placebo.

 

Our results highlight that the many hundreds of placebo-controlled trials of antidepressants have not addressed the most important, patient-relevant questions regarding antidepressants’ benefits and harms. Although this has been known for years,13 it has not led to changes in research practice. Erroneous conclusions that antidepressants are efficacious for depression have the effect that they may prevent people suffering from depression from seeking other solutions to alleviate their condition, such as psychotherapy and dealing with psychosocial stressors, and they may stall funding and research of such treatment modalities. Importantly, such conclusions may also lead to a loss of interest in providing a better evidence base to determine the true clinical value of antidepressants.

 

Our review has two implications. First, the review by Cipriani et al 5 and its conclusion should be carefully revisited. In the light of our findings, the review should not inform clinical practice. Second, our reanalysis has highlighted the need for a radical change in the way antidepressant trials are being conducted, reported and interpreted. We hope that doctors, patients, peers and politicians will consider the limitations of the current evidence of antidepressants for depression that we have presented and collectively act accordingly. This involves informing the patients about the limitations of the current evidence, thus providing a basis for a true informed consent, and working towards a better evidence base for the use of antidepressants in the treatment of depression. To get reliable answers about the antidepressants’ benefits and harms in adults with depression, we need large-scale, industry-independent and better blinded, long-term trials of drug naïve participants, with patient-relevant outcomes rather than ranking scales.

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Linus

Researcher Michael P. Hengartner PhD (follow him on twitter, he is great) about this reanalysis :

 

"So I think that it‘s quite safe to conclude that the bias-corrected difference between drug and placebo in RCT is significantly smaller than 2 HAMD points, presumably very close to 0."

 

So basically what this means is that antidepressants are no more effetive than sugar pills with potentially serious side effects and  the possibility you will suffer horrible withdrawal when you come off them.

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Onmyway

Let's see how pharma spins/blocks this one.

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Linus
On 7/10/2019 at 11:41 AM, Onmyway said:

Let's see how pharma spins/blocks this one. 

 

Maybe they won't even bother to reply... This also goes for all psychiatrists who, when the Cipriani meta-analysis came out, claimed the debate was settled: "antidepressants do work" (even though it only showed a two point improvement on the Hamilton depression scale in comparison with placebo, which may be statistically significant, but in my book is not clinically significant). Now with this re-analysis we know the difference is much smaller, probably zero, but I would not hold my breath in waiting for a reply by "establishement" psychiatrists.

 

Good luck with your taper, you can do this !

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