ReviewClinical therapeutics2011
Solving the antidepressant efficacy question: effect sizes in major depressive disorder.
Review in Clinical therapeutics, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 79 citations in OpenAlex.
- Neural, Anti-Inflammatory, and Clinical Effects of Transauricular Vagus Nerve Stimulation in Major Depressive Disorder: A Systematic Review.The international journal of neuropsychopharmacology · 2024Pooled it
- GRIK4 polymorphism and its association with antidepressant response in depressed patients: a meta-analysis.Pharmacogenomics · 2014Pooled it
- Effects of Blueberry Supplementation on Depression and Anxiety Symptoms in a Rural Louisiana Population.Nutrients · 2025Trial
- A Randomized Controlled Trial of Community-Delivered Heated Hatha Yoga for Moderate-to-Severe Depression.The Journal of clinical psychiatry · 2023Trial
- A double-blind, randomized, placebo-controlled trial of Lactobacillus helveticus and Bifidobacterium longum for the symptoms of depression.The Australian and New Zealand journal of psychiatry · 2017Trial
- Functional near-infrared spectroscopy-based diagnosis support system for distinguishing between mild and severe depression using machine learning approaches.Neurophotonics · 2024Article
- The Impact ofClinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2023Article
- Community-Delivered Heated Hatha Yoga as a Treatment for Depressive Symptoms: An Uncontrolled Pilot Study.Journal of alternative and complementary medicine (New York, N.Y.) · 2019Article
- Short- and Long-Term Antidepressant Clinical Trials for Major Depressive Disorder in Youth: Findings and Concerns.Frontiers in psychiatry · 2019Review
- Athanasios Koukopoulos' Psychiatry: The Primacy of Mania and the Limits of Antidepressants.Current neuropharmacology · 2017Review
- Antidepressants are not overprescribed for mild depression.The Journal of clinical psychiatry · 2015Article
- Differential co-expression and regulation analyses reveal different mechanisms underlying major depressive disorder and subsyndromal symptomatic depression.BMC bioinformatics · 2015Article
- An HDAC-dependent epigenetic mechanism that enhances the efficacy of the antidepressant drug fluoxetine.Scientific reports · 2015Article
- A systematic approach to pharmacotherapy for geriatric major depression.Clinics in geriatric medicine · 2014Review
- The genetics of major depression.Neuron · 2014Review
- Antidepressants: relationship to the time to psychiatric readmission and probability of being in hospital in depressive patients.Frontiers in public health · 2014Article
- US trends in quality-adjusted life expectancy from 1987 to 2008: combining national surveys to more broadly track the health of the nation.American journal of public health · 2013Article
- Genetic biomarkers of placebo response: what could it mean for future trial design?Clinical investigation · 2013Article
- Melancholic Features in Bipolar Depression and Response to Lamotrigine: A Pooled Analysis of Five Randomized Placebo-Controlled Trials.Journal of clinical psychopharmacologyArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundNumerous reviews and meta-analyses of the antidepressant literature in major depressive disorders (MDD), both acute and maintenance, have been published, some claiming that antidepressants are mostly ineffective and others that they are mostly effective, in either acute or maintenance treatment.
objectiveThe aims of this study were to review and critique the latest and most notable antidepressant MDD studies and to conduct our own reanalysis of the US Food and Drug Administration database studies specifically analyzed by Kirsch et al.
methodsWe gathered effect estimates of each MDD study. In our reanalysis of the acute depression studies, we corrected analyses for a statistical floor effect so that relative (instead of absolute) effect size differences were calculated. We also critiqued a recent meta-analysis of the maintenance treatment literature.
resultsOur reanalysis showed that antidepressant benefit is seen not only in severe depression but also in moderate depression and confirmed a lack of benefit for antidepressants over placebo in mild depression. Relative antidepressant versus placebo benefit increased linearly from 5% in mild depression to 12% in moderate depression to 16% in severe depression. The claim that antidepressants are completely ineffective, or even harmful, in maintenance treatment studies involves unawareness of the enriched design effect, which, in that analysis, was used to analyze placebo efficacy. The same problem exists for the standard interpretation of those studies, although they do not prove antidepressant efficacy either, since they are biased in favor of antidepressants.
conclusionsIn sum, we conclude that antidepressants are effective in acute depressive episodes that are moderate to severe but are not effective in mild depression. Except for the mildest depressive episodes, correction for the statistical floor effect proves that antidepressants are effective acutely. These considerations only apply to acute depression, however. For maintenance, the long-term efficacy of antidepressants is unproven, but the data do not support the conclusion that they are harmful.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.