Nierenberg, A. A., Ostacher, M. J., Huffman, J. C., Ametrano, R. M., Fava, M. & Perlis, R. H. (2008). Journal of Occupational and Environmental Medicine, 50(4), 428-436.
Objective: Antidepressants treat major depressive disorder (MDD) with the burden of associated side effects and difficulties with compliance. The purpose of this article is to review the efficacy and effectiveness of antidepressants for MDD. Methods: The authors conducted a focused review of selected key issues and references relevant to the clinically relevant pharmacologic treatment of MDD. Principles of treatment are reviewed. Antidepressants reviewed include SSRIs, mixed norepinephrine or serotonin uptake inhibitors, dopamine or norepinephrine uptake inhibitors, norepinephrine uptake inhibitors, antidepressants with mixed properties, and monoamine oxidase inhibitors. Augmentation and psychotherapy strategies are reviewed. Results: Antidepressant efficacy has been established in randomized clinical trials and effectiveness studies for acute and long-term treatment, but many patients do not achieve remission. Augmentation strategies and focused psychotherapy can be helpful. Conclusions: Antidepressants help most patients with MDD but some are resistant to treatment and have a difficult long-term course.
Prescriptive Authority in the Face of Research Revelations.
Greenberg, R. P. American Psychologist 65(4)
Fox and his colleagues (May-June 2009) listed three occurrence beginning in the 1980s that have dampened psychologists' desires to procure the right to prescribe psychotropic medications. One of the events noted was a review of antidepressant treatments that I co-authored (Greenberg & Fisher, 1989). That research review highlighted the fact that antidepressants produce a very modest effect at best when compared with placebos. Fox et al. went on to correctly note that the robust placebo effect on depression that we identified has been widely validated by subsequent studies. However, Fox et al. did not point out that since the 1980s, a great deal of research has demonstrated even more reason to raise questions about the benefits of antidepressants relative to placebos and psychotherapy. I briefly summarize here some of the important findings that emerged from our original survey and two more recent reviews (Greenberg & Davis Goldman, 2009; Greenberg & Fisher, 1997). Questions regarding antidepressants are of particular relevance in any discussion of prescription privileges because they are the most prescribed class of drugs in the United States (Spielmans Thiegles,Dent, & Greenberg, 2008).
Another reason to be concerned about the validity of proclamations regarding the therapeutic power of antidepressants rests on the finding that the published literature does not present an accurate picture of the results of effectiveness trials.
Evidence has revealed that the published literature is selective and skewed in a direction that is more positive than can be justified by looking at all the conducted antidepressant trials. For example, Turner, Matthews, Linardatos, Tell, and Rosenthal (2008) presented a report looking at the Food and Drug Administration (FDA)database for all the trials--both published and unpublished—of antidepressant agents approved for use between 1987 and 2004.
Only about half the trials showed placebo-drug differences. However, the published literature, by not reporting on 92% of the negative trials, misleads by implying that almost all the trials (94%) were positive.
In addition, selective reporting deceptively suggests an effect size that is about one third larger than the one computed by using all the studies in the FDA database.
Comparisons across our three major reviews (Greenberg & Davis Goldman,2009; Greenberg & Fisher, 1989, 1997) also revealed that virtually all studies show psychotherapy is either equal to or more effective thanmedications for the treatment of depression. Of particular importance is the fact that several studies indicate that psychotherapy provides two advantages over medications.