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Relevace of this paper to moderate depression

Posted by plosmedicine on 31 Mar 2009 at 00:21 GMT

Author: Andy Montgomery
Position: Psychiatrist
Institution: Plymouth UK
Submitted Date: February 26, 2008
Published Date: February 27, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

This is an interesting paper which aims to tackle the publication bias which has limited the value of previous meta-analyses of anti-depressant effects.

Much has been made of the conclusion that the data does not support the use of antidepressants in moderately severe depression, the effects in severe depression seem uncontroversial. However, I wonder if this data can legitimately address the issue of benefit to moderately depressed people as it only includes one study with that level of symptoms. The authors arrive at their conclusion using a curvilinear model which seems to have been driven by the outlying study. The linear model also shows convergence between placebo and drug effects at lower HDRS scores, although as they point out this seems to be due to a reduction in placebo effects in severe depression.

The authors imply a very black and white (or in this case green and white) area in which clinical significance is achieved using NICE's standard. However, there is no indication of the uncertainty of this estimate- would it not have been more helpful to have indicated the area of benefit with confidence intervals?

No competing interests declared.