Selective serotonin reuptake inhibitors: Evidence base for older antidepressants is shaky too

doi:10.1136/bmj.330.7488.420

BMJ 2005;330:420 (19 February), doi:10.1136/bmj.330.7488.420

Letter

Selective serotonin reuptake inhibitors

Evidence base for older antidepressants is shaky too

The first 150 words of the full text of this article appear below.

EDITOR—In contrast to Geddes and Cipriani's assertionof a lack of clinical uncertainty about the efficacy of antidepressants,¹a careful look at the evidence shows that this may not be true,even of the tricylic antidepressants. Although many trials showtricylic antidepressants to be superior to placebo, many findno difference, including some of the largest and best conductedolder trials.^2
3 In addition several factors are likely to haveinflated the apparent superiority of antidepressants over placebo.⁴

These include unblinding because of side effects of active drugscompared with inert placebos; and inclusion of items on ratingscales, such as sleep and agitation, which are likely to respondto non specific sedative effects of drugs. Since differencesoften amount to only a few points on rating scales, antidepressantsmay seem superior to placebo due to these effects alone. Theremaining factors are selective reporting of positive outcomes,excluding . . . [Full text of this article]

Joanna Moncrieff, senior lecturer

University College London, Department of Mental Health Sciences, London W1N 8AA j.moncrieff@ucl.ac.uk