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Wang SM, Han C, Lee SJ, Jun TY, Patkar AA, Masand PS, Pae CU. Efficacy of antidepressants: bias in randomized clinical trials and related issues. Expert Rev Clin Pharmacol 2017; 11:15-25. [PMID: 28893095 DOI: 10.1080/17512433.2017.1377070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Countless antidepressant randomized trials were conducted and showed statistically significant benefits of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) over placebo. Meanwhile, critics are increasing regarding the efficacy of antidepressants in the treatment of MDD because at least a proportion of clinical trials could be hampered by various biases. In contrast, number of failed trials is increasing in the recent years which have made developing psychiatric medications progressively more time-consuming and expensive. Areas covered: Biases and related issues in clinical trials for antidepressants can be identified as an important common contributing factor to the two paradoxical phenomenon. This review identifies possible biases that can occur before, during, and after clinical trials of antidepressant. Expert commentary: Recent studies not only may over-estimate efficacy of antidepressants, but also may exaggerate placebo response because of various biases. Sponsorship and publication biases have been one of the targets of the criticism and ethical debate. Thus, initiating new trend of research by re-organizing academic-industry partnership will be the most important task in the next five years.
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Affiliation(s)
- Sheng-Min Wang
- a Department of Psychiatry , The Catholic University of Korea College of Medicine , Seoul , Republic of Korea.,b International Health Care Center, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Changsu Han
- c Department of Psychiatry , Korea University, College of Medicine , Seoul , Republic of Korea
| | - Soo-Jung Lee
- a Department of Psychiatry , The Catholic University of Korea College of Medicine , Seoul , Republic of Korea
| | - Tae-Youn Jun
- a Department of Psychiatry , The Catholic University of Korea College of Medicine , Seoul , Republic of Korea
| | - Ashwin A Patkar
- d Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| | | | - Chi-Un Pae
- a Department of Psychiatry , The Catholic University of Korea College of Medicine , Seoul , Republic of Korea.,d Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
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Abstract
This opinion piece aims to situate the placebo effect within the field of psychiatric treatment. To accomplish this, the placebo is explored at the centre of an often heated debate between three discrete perspectives: the clinical trial researcher, the placebo researcher and the clinician. Each occupational perspective has its own vested interests and practical concerns that drive how the placebo concepts are negotiated and applied. It is argued that because the trial and placebo researchers typically represent opposing viewpoints, clinicians are generally uncomfortable or even baffled by placebo concepts, and this three-way tension has crucial implications for the field's progress.
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Dongier M, Brown TG. Reframing the placebo concept. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:703-4; author reply 704. [PMID: 22114927 DOI: 10.1177/070674371105601112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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