ArticleJournal of psychopharmacology (Oxford, England)2020
One (effect) size does not fit at all: Interpreting clinical significance and effect sizes in depression treatment trials.
Article in Journal of psychopharmacology (Oxford, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 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
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Dopamine in major depressive disorder: A systematic review and meta-analysis of in vivo imaging studies.Journal of psychopharmacology (Oxford, England) · 2023Pooled it
- The effects of psychotherapies for depression on response, remission, reliable change, and deterioration: A meta-analysis.Acta psychiatrica Scandinavica · 2021Pooled it
- Initial severity of the Positive and Negative Syndrome Scale (PANSS)-30, its main subscales plus the PANSS-6, and the relationship to subsequent improvement and trial dropout: a pooled participant-level analysis of 18 placebo-controlled risperidone and paliperidone trials.Translational psychiatry · 2023Trial
- Article
- The many-to-many problem of endophenotypes in psychiatry - a biological perspective.Molecular psychiatry · 2026Review
- Host-microbiome relationship in depression: can human induced pluripotent stem cells play a role in unravelling mechanisms?NPJ biofilms and microbiomes · 2025Review
- SSRIs: exploring controversies, conundrums, and contentions-epiphenomenon or empirical ingenuity? A comparative panorama for untangling enigma in children and youths.CNS spectrums · 2025Review
- Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2024Article
- Rationale and design of a double-blinded, randomized placebo-controlled trial of 40 Hz light neurostimulation therapy for depression (FELIX).Annals of medicine · 2024Article
- Neuroanatomical dimensions in medication-free individuals with major depressive disorder and treatment response to SSRI antidepressant medications or placebo.Nature. Mental health · 2024Article
- Educational Intervention Effects on Depression and Anxiety in Patients after Myocardial Infarction: A Randomized Controlled Trial.Journal of cardiovascular development and disease · 2023Article
- Fifty years on: Serotonin and depression.Journal of psychopharmacology (Oxford, England) · 2023Review
- Impact of chosen cutoff on response rate differences between selective serotonin reuptake inhibitors and placebo.Translational psychiatry · 2022Article
- Beyond Response: Aiming for Quality Remission in Depression.Advances in therapy · 2022Article
- Clinically meaningful changes on depressive symptom measures and patient-reported outcomes in patients with treatment-resistant depression.Acta psychiatrica Scandinavica · 2021Article
- Usefulness of Hamilton rating scale for depression subset scales and full versions for electroconvulsive therapy.PloS one · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
Abstract
The efficacy of antidepressants in major depressive disorder has been continually questioned, mainly on the basis of studies using the sum-score of the Hamilton Depression Rating Scale as a primary outcome parameter. On this measure antidepressants show a standardised mean difference of around 0.3, which some authors suggested is below the cut-off for clinical significance. Prompted by a recent review that, using this argument, concluded antidepressants should not be used for adults with major depressive disorder, we (a) review the evidence in support of the cut-off for clinical significance espoused in that article (a Hamilton Depression Rating Scale standardised mean difference of 0.875); (b) discuss the limitations of average Hamilton Depression Rating Scale sum-score differences between groups as measure of clinical significance; (c) explore alternative measures of clinical importance; and (d) suggest future directions to help overcome disagreements on how to define clinical significance. We conclude that (a) the proposed Hamilton Depression Rating Scale cut-off of 0.875 has no scientific basis and is likely misleading; (b) there is no agreed upon way of delineating clinically significant from clinically insignificant; (c) evidence suggests the Hamilton Depression Rating Scale sum-score underestimates antidepressant efficacy; and (d) future clinical trials should consider including measures directly reflective of functioning and wellbeing, in addition to measures focused on depression psychopathology.
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.