Continuing the antidepressant debate: the clinical relevance of drug-placebo differences

So, basically, taking an antidepressant is no better than taking a placebo… actually it’s worse because the antidepressant is more expensive and can have nasty side effects.

Joanna Moncrieff

German psychiatrist, Stefan Leucht and colleagues, have produced another really important paper (1). The results indicate that the small differences usually found between antidepressants and placebo are far below the sort of differences that would be clinically detectable or meaningful.

Leucht et al have conducted the first thorough, systematic attempt to provide some empirical evidence about what constitutes a clinically meaningful difference in scores on depression rating scales, such as the Hamilton Rating Scale for Depression. Although the study did not set out to explore antidepressant effects, these are the scales that are used to assess the efficacy of antidepressants in placebo-controlled trials. In 2004, the National Institute of Clinical Excellence declared that a Hamilton score difference of three points was clinically significant (2). This estimate seems to have been plucked out of the air, however. At least the Institute never provided any explanation of what it was based on…

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