ReviewEvidence-based mental health2018
The limitations of using randomised controlled trials as a basis for developing treatment guidelines.
Review in Evidence-based mental health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 7 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
52 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Post-marketing safety of CGRP monoclonal antibodies and gepants: A systematic review of spontaneous reporting system data.Headache · 2026Pooled it
- Pooled it
- Microbial colonisation associated with conventional and self-ligating brackets: a systematic review.Journal of orthodontics · 2022Pooled it
- Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews.Journal of medical Internet research · 2021Pooled it
- Do proton pump inhibitors increase mortality? A systematic review and in-depth analysis of the evidence.Pharmacology research & perspectives · 2020Pooled it
- Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis.Nutrients · 2020Pooled it
- Economic Evaluations Informed Exclusively by Real World Data: A Systematic Review.International journal of environmental research and public health · 2020Pooled it
- Pilot evaluation of an educational and lived experience training program on ketogenic metabolic therapy in mental health care for health care professionals.Frontiers in psychiatry · 2026Trial
- Safety and immunogenicity of three dose levels of an investigational, highly purified Vero cell rabies vaccine: A randomized, controlled, observer-blinded, Phase II study with a simulated post-exposure regimen in healthy adults.Human vaccines & immunotherapeutics · 2023Trial
- Women's Usage Behavior and Perceived Usefulness with Using a Mobile Health Application for Gestational Diabetes Mellitus: Mixed-Methods Study.International journal of environmental research and public health · 2021Trial
- Systematic and Collaborative Approach to Learning and Educational Content Development (SCALED) for Health Apps: An Experience-Informed Conceptual Framework.JMIR mHealth and uHealth · 2026Article
- Beyond RCTs-Better Research Designs and Methods for Psychosocial Efficacy Studies in Mental Health.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2026Review
- Impact of traditional Korean medicine on suicide prevention in depression: A nationwide 10-year follow-up study.Journal of traditional and complementary medicine · 2026Article
- Article
- Article
- Individualized prescriptive inference in ischaemic stroke.Nature communications · 2025Article
- Switch to mania after acute antidepressant treatment for bipolar depression: a systematic review and network meta-analysis of randomised controlled trials.EClinicalMedicine · 2025Article
- Variational temporal deconfounder network for individualized treatment effect estimation with longitudinal observational data.Journal of biomedical informatics · 2025Article
- Practice-based research examining effectiveness of exposure-based CBT for youth in a community mental health setting.Journal of mood and anxiety disorders · 2025Article
- Development of the treatment prediction model in the artificial intelligence in depression - medication enhancement study.Npj mental health research · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Randomised controlled trials (RCTs) are considered the 'gold standard' by which novel psychotropic medications and psychological interventions are evaluated and consequently adopted into widespread clinical practice. However, there are some limitations to using RCTs as the basis for developing treatment guidelines. While RCTs allow researchers to determine whether a given medication or intervention is effective in a specific patient sample, for practicing clinicians it is more important to know whether it will work for their particular patient in their particular setting. This information cannot be garnered from an RCT. These inherent limitations are exacerbated by biases in design, recruitment, sample populations and data analysis that are inevitable in real-world studies. While trial registration and CONSORT have been implemented to correct and improve these issues, it is worrying that many trials fail to achieve such standards and yet their findings are used to inform clinical decision making. This perspective piece questions the assumptions of RCTs and highlights the widespread distortion of findings that currently undermine the credibility of this powerful design. It is recommended that the clinical guidelines include advice as to what should be considered good and relevant evidence and that external bodies continue to monitor RCTs to ensure that the outcomes published indeed reflect reality.
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.