title: Understanding the Antidepressant Debate in the Treatment of Major Depressive Disorder.
abstract: There is a long-standing polemic concerning the usefulness of antidepressants in the treatment of major depressive disorder. In this paper, we propose to highlight some aspects of this controversy by exploring the mutual influence of psychopharmacology and trial methodologies. Indeed, antidepressant efficacy, if not proved, was accepted before antidepressant randomised controlled trials (RCTs) were run. While RCTs became a gold standard to meet the requirements of the regulatory bodies, methodological tools were required to measure outcomes and to test whether antidepressants provide statistically significant benefits as compared with a placebo. All these methodological options have nonetheless introduced fuzziness in our interpretation of study results, in terms of clinical meaningfulness and in terms of transposability to a real life settings. Additionally, selective publication raises concerns about the published literature, and results in many paradoxes. Instead of providing easy answers, the application of the RCT paradigm in MDD raises numerous questions. This is probably in the nature of all scientific studies, but it can be in contradiction with clinicians' expectations, who want to be sure that the treatment will (or will not) work for their individual patients.
authors: INSERM U669, Paris, France - Centre d'Investigation Clinique CIC-P INSERM 1414, Hôpital de Pontchaillou, Centre Hospitalier Universitaire de Rennes & Université de Rennes 1, Rennes, France - Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de psychiatrie, Rennes, France.
authors: Florian
authors: F
authors: Naudet
authors: Faculté de Médecine de Poitiers, Département de Médecine Générale, Poitiers, France.
authors: Rémy
authors: R
authors: Boussageon
authors: Centre d'Investigation Clinique CIC-P INSERM 1414, Hôpital de Pontchaillou, Centre Hospitalier Universitaire de Rennes & Université de Rennes 1, Rennes, France.
authors: Clément
authors: C
authors: Palpacuer
authors: Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de psychiatrie, Rennes, France.
authors: Laurent
authors: L
authors: Gallet
authors: Centre d'Investigation Clinique CIC-P INSERM 1414, Hôpital de Pontchaillou, Centre Hospitalier Universitaire de Rennes & Université de Rennes 1, Rennes, France - Laboratoire de Pharmacologie Expérimentale et Clinique, Faculté de Médecine de Rennes, Rennes, France.
authors: Jean-Michel
authors: JM
authors: Reymann
authors: INSERM U669, Paris, France - Université Paris-Sud et Université Paris Descartes, UMR-S0669, Paris, France - AP-HP, Hôpital Paul Brousse, Département de Santé Publique, Villejuif, France.
authors: Bruno
authors: B
authors: Falissard
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D015340:Epidemiologic Research Design; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents