Section - Quick Takes

03. Considering the Methodological Limitations in the Evidence Base of Antidepressants for Depression: A Reanalysis of a Network Meta-Analysis

Published on July 1, 2023 Certification expiration date: July 1, 2026

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

Dr. Klaus Munkholm and colleagues reviewed 8 meta-analyses of antidepressant efficacy, including a total of 250 randomized trials.
Across these meta-analyses, the average effect size of antidepressants relative to placebo was 0.29.
Recall that in general, an effect size of 1.0 is regarded as large, 0.5 medium, and 0.2 small.

To unlock this audio you need to become a Silver, Gold, Silver extended or Gold extended Member.

Check Our CME Program

Downloads for Offline Access

Download Audio File (MP3)

Text version

How effective are antidepressants compared with placebo? If the answer is a lot, then perhaps their risks are justified. If the answer is just barely, then it would be hard to justify subjecting patients to the risks of sexual dysfunction, weight gain, and potential severe withdrawal on discontinuation.

Hi! Jim Phelps here for the Psychopharmacology Institute. Let’s compare the effectiveness of antidepressants vs placebo for the treatment of depression as found in 8 different meta-analyses of a total of 253 trials. Our yardstick for the comparison of antidepressants vs placebo is effect size. Remember how effect sizes work. Take the difference between improvement in mood on antidepressant vs the improvement in mood on placebo. For example, on the Hamilton Depression Scale, the average difference between those improvements was 1.97 points. Now, to make different studies more comparable, factor in the precision of the outcome measure in each study as indicated

Unlock this Quick Take and earn 0.50 CMEs
Become a Silver, Gold, Silver extended or Gold extended Member.

Get Instant Access

Already have an account? Sign in

Next Section

04. Distinguishing Relapse From Antidepressant Withdrawal: Clinical Practice and Antidepressant Discontinuation Studies

Learning Objectives:

Discuss the importance of nonmanic markers in assessing bipolar features among patients.
Consider the implications of a dimensional approach to the diagnosis of depressive disorders with mixed features and its impact on treatment options.
Evaluate the benefit–risk ratio of antidepressants in light of the results of 8 large meta-analyses.
Reassess the incidence of severe withdrawal symptoms when antidepressants are discontinued and clinical features which distinguish withdrawal from relapse.
Compare the first- and second-line treatment options for bipolar depression in 2 recent treatment guidelines.

Original Release Date: July 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: July 1, 2026

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

James Phelps declares the following interests:

- McGraw-Hill Publishing Company: Royalties
- W.W. Norton & Co. Publishing Company: royalties

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:

Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
Download your certificate.

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.