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Immoderate Conclussion on Moderate Depression

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

Author: stephen davies
Position: Consultant Psychiatrist
Institution: Swansea NHS Trust
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.

Kirsch et al should be congratulated for obtaining unpublished drug company data through freedom of information legislation, and their paper should be widely read because of this.

But instead, it is being widely quoted in the media as evidence that antidepressants don't work except in the most severe cases. This would seem to me to be an unjustified conclussion.

The authors clearly state that "for all but one sample, baseline HRSD scores were in the very severe range", and that only one paper included in the meta-analasis looked at patients with moderate depression. They conclude that "efficacy reaches clinical significance only in trials involving the most extremely depressed patients". It appears that the editor has extended this conclussion to mean that "the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression" EVEN THOUGH the authors do not explicitly state this. In fact they add that the results might be different if more data was available.

I am not a statistician. But I find it very dubious to make such claims about moderate depression when only one one piece of research that looks at patients with moderate depression is included in a meta-analysis. Essentially that would be a meta-analysis of 1 paper, and a separate meta-analysis of severe depression.

Finally, some of the papers will have looked at a range of antidepressant dosages. If data on response related to dose is available, perhaps the authors would like to publish that too.

No competing interests declared.