Are the drugs better than the placebo?

Do monotherapy antidepressants improve symptoms in patients with major depression? This is the question that an American team was interested in, by collecting no less than 232 clinical studies, randomized with placebo, involving a total of 73,388 adults, between 1976 and 2016.

The Hamilton Rating Scale for Depression (HAMD17) was used to assess the effectiveness of different therapies. Multivariate analyzes examined the effects of age, gender, baseline depression severity, and year of study on improvement in depressive symptoms in the antidepressant-treated and antidepressant-treated groups. placebo.

The differences between drugs and placebo increased significantly (P<0.001) the more severe the disease. On average, there was a difference of about 15% in favor of antidepressants versus placebo.

According to the authors of this study, “although the average effect of antidepressants provides only a small improvement compared to the placebothe effect of the active drug appears to increase the likelihood that any patient will derive substantial benefit…Further research is needed to identify the subset of patients likely to need antidepressants”.

Stone MB et al. : Response to Acute Monotherapy for Major Depressive Disorder in Randomized Placebo-Controlled Trials Submitted to the United States Food and Drug Administration: Analysis of Individual Participant Data
BMJ2022;378:e067606
https://www.bmj.com/content/bmj/378/bmj-2021-067606.full.pdf