You can view a video about how to appraise a systematic review and meta-analysis. Systematic reviews and meta-analyses of Randomised controlled trials (RCT’s) lie at the top of the hierarchy of evidence-based medicine and are essential tools in highlighting the effectiveness of interventions. This network meta-analysis was more extensive and included a comprehensive list of 21 antidepressants and placebo which were compared by using the most advanced statistical methodology for network meta-analysis to date. In February 2018, a systematic review and network meta-analysis was published by Cipriani and colleagues, which compared the efficacy and acceptability of antidepressants to treat major depressive disorder. The efficacy of antidepressants has therefore been debated for at least a decade. For patients with very severe depression, the benefit of medications over placebo is substantial. The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication (Kirsch et al 2008).įournier and colleagues then supported the observation that antidepressants show a magnitude of benefit only for cases of severe depression (HDRS>25). In this data set, the placebo response was shown to be responsible for 82% of the response observed with antidepressant therapy.ĭrug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. However, in 2008, Kirsch repeated his work using a different set of clinical trials by requesting the FDA to divulge unpublished research from pharmaceutical companies. This article reached a controversial conclusion, and the methodology was criticised, whereby the analysis was subject to significant clinical, methodological and statistical heterogeneity. Here, it was shown that the placebo response was calculated to be responsible for 75% of the response to active antidepressant medication. In this publication, the mean change in depressive scores was compared between placebo and antidepressant. In 1998, Irving Kirsch published a meta-analysis of 19 placebo-controlled double-blind clinical trials. However, there is considerable debate on their effectiveness because their short-term benefits are modest and the long-term benefits and harms are under-researched. Antidepressants are widely used treatments for major depressive disorder.
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