title: The small specific effects of antidepressants in clinical trials: what do they mean to psychiatrists?
abstract: Although antidepressants continue to be a mainstay for clinicians who treat people suffering from depressive disorders, there have recently been articles published in both the scientific literature and the popular press that have raised questions about the utility of this class of medications. This paper briefly examines recent meta-analyses that have reported small drug versus placebo differences in randomized controlled trials and, from the perspective of a prescribing psychiatrist, discusses the clinical significance of these findings. It is concluded that antidepressants do have relatively modest effects (as compared with placebo) in contemporary randomized controlled trials, and that the contribution of placebo-expectancy factors to individual outcomes is often underestimated. Nevertheless, it is also concluded that the modest benefits of antidepressants in grouped datasets obscure large, specific, and very meaningful therapeutic effects for 10% to 20% of those treated with antidepressants.
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Perelman School of Medicine of the University of Pennsylvania, University of Pittsburgh Medical Center, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA. thase@mail.med.upenn.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic / Q000592:standards*
chemical_list: D000928:Antidepressive Agents