Steroids and antidepressant response

Meta‐analysis of antidepressant effects of anti‐inflammatory drugs—reply

“…We thank Dr. Balon (1) and Drs. Baldessarini and V azquez (2) for their letters concerning our meta-analysis of randomized clinical trials (RCTs) showing antidepressant effects of anti-inflammatory agents (3). The authors emphasize several important aspects, which we would like to comment on to continue this important discussion.…”

“…The placebo-controlled, relapse prevention studies (PCRPS) have recently been singled out as redundant, disproportionately harmful, unnecessary and therefore ethically impermissible (1). The logic of comparison behind PCRPS has also been questioned as they apply different methodological procedures, such as duration of treatment prior to randomization and/or different treatment discontinuation strategies (2). Furthermore, there seems to be a real threat that withdrawal syndromes and other overlapping phenomena (such as rebound effects) cannot be reliably distinguished from relapse (as primary endpoint) and as such have high confounding potential (2).…”

“…The logic of comparison behind PCRPS has also been questioned as they apply different methodological procedures, such as duration of treatment prior to randomization and/or different treatment discontinuation strategies (2). Furthermore, there seems to be a real threat that withdrawal syndromes and other overlapping phenomena (such as rebound effects) cannot be reliably distinguished from relapse (as primary endpoint) and as such have high confounding potential (2). However, relapse and its prevention remain a critical subject that needs to be comprehensively researched in schizophrenia and related disorders.…”