Antidepressant Treatment of Depression: A Metaanalysis

Joffe, Russell T.; Sokolov, Stephen T.H.; Streiner, David L.

doi:10.1177/070674379604101002

Cited by 107 publications

(70 citation statements)

References 38 publications

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“…In Joffe and others' metaanalysis of the effectiveness of antidepressants, it is possible to compute an effect size of r = 0.24 (22). To capture an effect of that size reliably, a sample size of 120 (60 per group) is required to find significant results 80% of the time (K Parker, personal communication, March 2004).…”

Section: Discussionmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitor and Venlafaxine Use in Children and Adolescents with Major Depressive Disorder: A Systematic Review of Published Randomized Controlled Trials

Courtney

2004

Can J Psychiatry

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Objective: This review critiques published randomized placebo-controlled trials pertaining to the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) and venlafaxine in the treatment of major depressive disorder in children and adolescents. Method:Medline was searched for articles meeting defined inclusion criteria. The following key terms were used: depressive disorders, antidepressive agents, fluoxetine, paroxetine, sertraline, citalopram, fluvoxamine, venlafaxine, child, and adolescent.Results: Six articles met inclusion criteria. Only 2 studies claim efficacy by significant results in primary outcomes; both have since been contested in further analysis. Not one study adequately examines safety, particularly with respect to whether a link exists between antidepressant use and induction of suicidal ideation or attempts. Conclusion:Published studies on SSRI or venlafaxine use in children and adolescents are inconclusive with respect to safety and efficacy, owing to inappropriate claims of efficacy, lack of improvement in global functioning scores, nonstandardized data collection regarding adverse effects, exclusion of suicidal subjects in the recruitment process, grouping of children and adolescents together, small sample sizes, conflict of interest posed by pharmaceutical company sponsorship, and publishing bias. Future investigators should consider these factors when developing study designs. (Can J Psychiatry 2004;49:557-563) Information on author affiliations appears at the end of the article. Clinical Implications· Published evidence regarding the efficacy of selective serotonin reuptake inhibitor (SSRI) and venlafaxine use in children and adolescents with major depression is inconclusive. · Published evidence regarding the safety of SSRI and venlafaxine use in children and adolescents with major depression is also inconclusive. · For future studies of this issue to be clinically relevant, researchers should base claims of efficacy on primary outcomes, should adequately measure suicidal ideation and behaviours, and should have nonindustry funding. Limitations· Unpublished studies were not included in the review.

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Section: Discussionmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitor and Venlafaxine Use in Children and Adolescents with Major Depressive Disorder: A Systematic Review of Published Randomized Controlled Trials

Courtney

2004

Can J Psychiatry

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“…3,4 Up to 40% of depressed patients fail to show a response to fi rst-line antidepressant drug treatment, 5 and of those that do respond, only a proportion will achieve full recovery.…”

Section: Methodsmentioning

confidence: 99%

“…3,4 Up to 40% of depressed patients fail to show a response to fi rst-line antidepressant drug treatment, 5 and of those that do respond, only a proportion will achieve full recovery. 6 One cohort study of primary care patients found that 60% of depressed patients treated with medication and 50% with milder depression still met the criteria for caseness at 1 year.…”

mentioning

confidence: 99%

“…Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo. Doubts about the effectiveness of antidepressant medication and other therapies, such as cognitive therapy, may contribute to the variability in primary care management of depression.3,4 Up to 40% of depressed patients fail to show a response to fi rst-line antidepressant drug treatment, 5 and of those that do respond, only a proportion will achieve full recovery.6 One cohort study of primary care patients found that 60% of depressed patients treated with medication and 50% with milder depression still met the criteria for caseness at 1 year. …”

mentioning

confidence: 99%

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Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

Arroll

MacGillivray²,

Ogston³

et al. 2005

The Annals of Family Medicine

300

166

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PURPOSE Depression is common in primary care. There are no systematic reviews of depression treatment comparing antidepressants with placebo; hence, we do not know whether these medications are effective in primary care. METHODSWe searched the Cochrane Collaboration Depression, Anxiety and Neurosis Group register of controlled trials, MEDLINE, International Pharmaceutical abstracts, PsycINFO, and EMBASE. Abstracts of potential studies were reviewed independently by 2 authors. Studies needed to include randomized controlled trials of either a tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI), or both, and placebo in a primary care setting. The data and quality of the studies were extracted and assessed by 2 authors blind to the other's choice. Disagreements were resolved by discussion. The main outcome measures were the standardized mean difference and weighted mean difference of the fi nal mean depression scores, the relative risk of improvement, and the number withdrawing because of side effects. Pooling of results was done using Review Manager 4.2.2.RESULTS There were 10 studies in which TCAs were compared with placebo, 3 in which SSRIs were compared with placebo, and 2 with both compared with placebo. One half of the studies were of low methodological quality, and nearly all studies were of short duration, typically 6 to 8 weeks. Pooled estimates of effi cacy data showed a relative risk of 1.26 (95% CI, 1.12-1.42) for improvement with TCAs compared with placebo; For SSRIs, relative risk was 1.37 (95% CI, 1.21-1.55). Most patients, 56% to 60%, responded well to active treatment compared with 42% to 47% for placebo. The number needed to treat for TCAs was about 4, and for SSRIs it was 6. The numbers needed to harm (for withdrawal caused by side effects) ranged from 5 to 11 for TCAs and 21 to 94 for SSRIs. Low-dose (100 mg or 75 mg) as well as high-dose TCAs were effective.CONCLUSION This systematic review is the fi rst comparing antidepressants with placebo for treatment of depression in primary care. Both TCAs and SSRIs are effective. This review is also the fi rst to show that low-dose TCAs are effective in primary care. Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo. Doubts about the effectiveness of antidepressant medication and other therapies, such as cognitive therapy, may contribute to the variability in primary care management of depression.3,4 Up to 40% of depressed patients fail to show a response to fi rst-line antidepressant drug treatment, 5 and of those that do respond, only a proportion will achieve full recovery.6 One cohort study of primary care patients found that 60% of depressed patients treated with medication and 50% with milder depression still met the criteria for caseness at 1 year. 7Recent reports have indicated an urgent need to review the evidence of only those studies of antidepressant effi cacy on patient samples based in primary care. 8,9 Several completed reviews and protocols are c...

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“…(20) exposant une méta-analyse y réplique en concluant : « Une ana lyse plus at ten tive soutient la validité d'études rapportant des essais avec les antidépresseurs qui avaient été présentées comme de validité douteuse. » Cette réplique rejoint le constat en faveur de l'efficacité des antidépresseurs présenté dans une autre méta-ana lyse portant sur les essais réalisés en tre 1966 et 1995 (21). Des progrès sont cependant vivement attendus quant à la manière de publier les résultats dans toute la doc u men ta tion médicale, comme en témoigne une re vue cri tique et lucide sur la ques tion (22).…”

Section: Les Antidépresseurs Sont-ils Efficaces Pour Traiter La Dépreunclassified

« What's up, doc? » Le contexte, les limites et les enjeux de la médecine fondée sur des données probantes pour les cliniciens (Evidence-Based Medicine)

2001

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IntroductionIntitulé d'après la phrase déstructurante du célèbre personnage de bandes dessinées américain, cet essai tente de soumettre l'approche de la pra tique fondée sur les données probantes (Ev i dence-Based Med i cine que nous désignerons dorénavant sous l'acronyme EBM) à un re gard cri tique s'adressant aux cliniciens. On doit se de mander si cette nouvelle approche, qui sem ble déferler comme une mode, n'est pas une nou velle façon de nommer la dialectique de la médecine moderne en tre la pra tique d'un art et l'éclairage des meilleurs in stru ments et données de la sci ence. Ou peut-être sommes-nous, surtout en psychiatrie, à la croisée des chemins où la prise en compte des données probantes devient incontournable.Cette approche ne peut que provoquer des réactions de la part des cliniciens. On peut ici tracer le parallèle, qui n'est pas une coïncidence, avec la de scrip tion humoristique que Mar tin Knapp a faite de l'introduction de l'économique dans l'évaluation des ser vices, de la gestion et des décisions liés à la santé (1). Il décrit cinq âges : le pre mier est celui de l'innocence où l'économique n'a absolument rien à faire avec la santé et où les cliniciens se concentrent sur les soins de leurs pa tients; le deuxième âge est celui du déni-l'introduction des contraintes budgétaires et du raisonnement économique provoque une réaction presque de rage selon laquelle il y a incompatibilité en tre les considérations économiques et celles des choix thérapeutiques offerts ou prodigués par les cliniciens à leurs pa tients; le troisième âge est celui de l'acceptation aveugle dans lequel toute évaluation ou toute prop o si tion assortie d'une composante économique devient automatiquement acceptée; le quatrième âge est celui de l'intégration cri tique de l'approche et des recherches d'économie de la santé à la gestion et, progressivement, aux pra tiques cliniques, et enfin, le cinquième âge est celui de la sub li ma tion et de l'harmonie où l'approche économique est reconnue comme celle des choix éclairés et où un en sem ble de valeurs sont prises en compte, dont évidemment celles du rendement, de l'efficacité et de la productivité, mais également de l'équité, de l'autonomie, de la continuité et de la vi sion holistique de la personne et des soins. Ne peut-on craindre que l'approche fondée sur les données probantes, comme la décrivent les protagonistes que sont les auteurs du pre mier ar ti cle de ce numéro, ne se trouve actuellement en tre le deuxième et le troisième âge (2)? Face à cette véritable ma chine scientifique, qui remet en ques tion nombre des pra tiques, il faut effectuer une cri tique de la méthode qui sous-tend des méta-anal y ses menées notamment selon la méthode du groupe Cochrane. Tel l'arroseur arrosé, célèbre saynète des frères Lumière filmée au début du siècle der nier, on peut faire preuve d'un cer tain scepticisme à l'égard de l'épistémologie et des méthodes sous-tendant l'approche fondée sur les données probantes. Toute intégration de cette approche représente aussi un véritable cha...

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Antidepressant Treatment of Depression: A Metaanalysis

Abstract: We conclude that the superior efficacy of antidepressants over placebo can be demonstrated.

Cited by 107 publications

References 38 publications

Selective Serotonin Reuptake Inhibitor and Venlafaxine Use in Children and Adolescents with Major Depressive Disorder: A Systematic Review of Published Randomized Controlled Trials

Selective Serotonin Reuptake Inhibitor and Venlafaxine Use in Children and Adolescents with Major Depressive Disorder: A Systematic Review of Published Randomized Controlled Trials

Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

« What's up, doc? » Le contexte, les limites et les enjeux de la médecine fondée sur des données probantes pour les cliniciens (Evidence-Based Medicine)

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