Kaleidoscope - Volume 221 , Issue 4

Tracy, Derek K.; Joyce, Dan W.; Albertson, Dawn N.; Shergill, Sukhwinder S.

Abstract

Antidepressants and electroconvulsive therapy (ECT) are two areas of mental health where there are strong polarised views on the available data. Writing in the BMJ, Stone et alReference Stone, Yaseen, Miller, Richardville, Kalaria and Kirsch1 explored 232 placebo-controlled randomised controlled trials (RCTs) of antidepressant monotherapy for major depressive disorders submitted by a drug manufacturer to the Food and Drug Administration between 1979 and 2016. Individual participant level analysis was undertaken on the more than 73 000 subjects and showed positive drug efficacy, which was greater in more severe illness. After controlling for baseline severity, age and gender, effects were stable across the period in both placebo and active intervention groups, rebutting the common claim that placebo responses have been increasing with time. More interesting was the trimodal response distribution into large, non-specific and minimal responses. Those treated with active medication were more likely to show a large response and less likely to show a minimal response. The authors argue that delineating trials more simply into responders/non-responders misses this nuance, and that averaging out results hides subpopulations. This brings us back to an issue we have discussed in Kaleidoscope previously: the range of depressions and how we prospectively delineate the genetic, psychological and social factors that make individuals more or less likely to show an optimal response to an antidepressant.

Citation

Tracy, D. K., Joyce, D. W., Albertson, D. N., & Shergill, S. S. (2022). Kaleidoscope - Volume 221 , Issue 4. British Journal of Psychiatry, 221(4), 651-652. https://doi.org/10.1192/bjp.2022.127

• Journal Article Type: Editorial
• Acceptance Date: Oct 1, 2022
• Online Publication Date: Sep 26, 2022
• Publication Date: Oct 1, 2022
• Deposit Date: Jun 21, 2023
• Journal: British Journal of Psychiatry
• Print ISSN: 0007-1250
• Electronic ISSN: 1472-1465
• Publisher: Cambridge University Press (CUP)
• Peer Reviewed: Not Peer Reviewed
• Volume: 221
• Issue: 4
• Pages: 651-652
• DOI: https://doi.org/10.1192/bjp.2022.127
• Public URL: https://uwe-repository.worktribe.com/output/10881042
• Publisher URL: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/kaleidoscope/01B1EC8A3DF21A13DEE35BCFA6B386AF