A meta-analysis of antidepressant outcome under "blinder" conditions.

Greenberg, Roger P.; Bornstein, Robert F.; Greenberg, Michael D.; Fisher, Seymour

doi:10.1037/0022-006x.60.5.664

Cited by 156 publications

(124 citation statements)

References 31 publications

(46 reference statements)

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“…However, the anxiety effect is not a great deal smaller than the overall mean of 0.5 found by Lipsey and Wilson (1993) in their meta-analysis of meta-analyses of psychological interventions in many settings. Also four meta-analyses of antidepressants for depression have reported effect sizes between 0.19 and 0.79 (Smith et al, 1980;Shapiro and Shapiro, 1982;Quality Assurance Project, 1983;Steinbrueck et al, 1983;Greenberg et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses

Sheard

Maguire²

1999

Br J Cancer

493

332

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Between 15 and 40% of cancer patients develop clinical anxiety and/or depression (Derogatis et al, 1983;Massie and Holland, 1990;Parle et al, 1996). Even for those ostensibly cured the prevalence remains appreciably higher than that of the general population a year or more after diagnosis (Devlen et al, 1987). This evidence, combined with significant pressure from service users, has led to increasing provision of psychological interventions in British oncology services. This has been piecemeal (Fallowfield, 1988) and guided more by local factors than evidence of efficacy. There is little evidence based consensus about optimal methods of intervention, appropriate standards for clinical practice and training, or whether service provision is best directed towards prevention or the treatment of disorder (Fallowfield and Roberts, 1992;Hopwood and Maguire, 1992;Brennan and Sheard, 1994).The impact of psychological interventions in oncology on psychosocial, disease, symptom and treatment side-effect outcomes has been evaluated in a relatively large number of trials which vary considerably in their research questions, methodology, settings and results. Meyer and Mark (1995) aggregated all psychological outcomes for 45 such trials and reported a small mean effect size of 0.24 standard deviations for a single aggregate measure of psychological outcome. Their broad entry criteria ensured the inclusion of a large number of trials but the resulting extreme heterogeneity in terms of diversity of research questions and outcome measures render the meaning of this aggregate finding difficult to assess. We conducted, therefore, two metaanalyses of trials of interventions which sought to treat or prevent anxiety and/or depression. The relevance of the findings to clinical practice and service provision is assessed. METHODS Identical methods were used for the two meta-analyses Search strategyMedline, PsycLit and BIDS social sciences computerized databases were searched using the using the keywords cancer, counselling, psychotherapy, psychological therapy, group support/therapy, relaxation, imagery and visualization. Citations in identified papers and reviews (Watson, 1983;Cunningham, 1988;Vachon, 1988;Harman, 1991;Andersen, 1992;Trijsburg et al, 1992), Aslib. index to theses (keywords cancer, counselling and psychotherapy), and Comprehensive Dissertation Abstracts: Psychology (keyword cancer) were manually searched. SummaryThe findings of two meta-analyses of trials of psychological interventions in patients with cancer are presented: the first using anxiety and the second depression, as a main outcome measure. The majority of the trials were preventative, selecting subjects on the basis of a cancer diagnosis rather than on psychological criteria. For anxiety, 25 trials were identified and six were excluded because of missing data. The remaining 19 trials (including five unpublished) had a combined effect size of 0.42 standard deviations in favour of treatment against no-treatment controls (95% confidence interval (CI) 0.08-0.74, ...

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Section: Discussionmentioning

confidence: 99%

The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses

Sheard

Maguire²

1999

Br J Cancer

493

332

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“…This amplified placebo effect is difficult to demonstrate empirically, but several metaanalyses have found that trials with more rigorously blind conditions demonstrated lower medication effects, compared with placebo, than other trials. 2,3 These metaanalyses have been criticized with some justification, partly owing to the low quality of the included trials. Nevertheless, although critics are right to point out that the effects of placebo amplification have not been conclusively demonstrated, neither have they been refuted.…”

Section: Short-term Studiesmentioning

confidence: 99%

Are Antidepressants as Effective as Claimed? No, They are Not Effective at All

Moncrieff

2007

Can J Psychiatry

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A ntidepressant drugs are claimed to have specific effects on depressive symptoms. It is assumed that they do this by acting on an abnormal brain state that gives rise to depression. In contrast, I suggest that there is no evidence for this position. The effects of antidepressants seen in depression trials can easily be accounted for by nonspecific pharmacologic and psychological actions. Short-Term StudiesThere are thousands of randomized controlled trials (RCTs) comparing antidepressants with placebo, using various measures of depression. Metaanalyses of these have generally come to the conclusion that, overall, they show a small advantage for antidepressants. However, this obscures enormous heterogeneity among published study results, with many trials finding no difference between antidepressant medication and placebo. In addition, we know that negative trials are less likely to be published than positive ones and that positive outcomes are selectively reported within trials. A recent metaanalysis that included unpublished studies found that the difference between antidepressants and placebo amounted to less than 2 points on the Hamilton Depression Rating Scale (HDRS). 1There are 2 reasons why the small difference found in this and other recent metaanalyses does not necessarily imply that antidepressants have a truly "antidepressant" effect. First, all rating scales contain items-such as sleeping difficulties, anxiety, and agitation-that are not specific to depression and that are likely to respond to nonspecific sedative effects associated with many antidepressants. For example, the HDRS contains 6 such items; these can score a total of 16 points (a score of 19 to 20 points indicates severe depression as defined by the American Psychiatric Association). Therefore, improvements according to rating scales may simply reflect nonspecific effects and do not necessarily imply any change in mood, per se. Second, antidepressants are active drugs and, as such, produce a range of physiological effects when ingested.These effects may indicate to assessors or trial participants whether they are taking the antidepressant or the placebo; thus, the double-blind design is often penetrated in trials of antidepressants and other psychotropic agents. This is especially likely to happen in contemporary trials in which subjects are forewarned in detail about the randomized design, the use of placebo, and the nature of likely side effects. Patients on antidepressants may therefore experience an amplified placebo effect as a consequence of suspecting that they are taking the active drug. Similarly, raters may inflate ratings for individuals they suspect to be taking the active drugs on the basis of reported side effects. This amplified placebo effect is difficult to demonstrate empirically, but several metaanalyses have found that trials with more rigorously blind conditions demonstrated lower medication effects, compared with placebo, than other trials.2,3 These metaanalyses have been criticized with some justification, partly ow...

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“…What we talk about is actually alexithymia.Coles et al (15) believes that people suffering from stomatopyrosis have hidden energy as a psychical disturbance, as this is what the test he conducted revealed. Domb and Chole (3) studied the possibility of cancerophobia being a mental etiological factor with respondents suffering from stomatopyrosis and the results he obtained showed a high percentage of the interrelatedness between cancerophobia and stomatopyrosis.Greenberg et al (16,17,18) concluded that psychotherapy and psychopharmacotherapy are very successful in treating BMS which has occurred as a result of a mental disturbance.Botha (19) dealt with people suffering from stomatopyrosis in whose etiology there was a psychogenic factor. He concluded that psychotherapy and psychopharmacotherapy gave excellent results.…”

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confidence: 99%

Anxiolytics, Antidepressants and Autogenous training in the therapy of burning mouth syndrome

Pokupec¹

2013

iosrphr

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A meta-analysis of antidepressant outcome under "blinder" conditions.

Cited by 156 publications

References 31 publications

The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses

The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses

Are Antidepressants as Effective as Claimed? No, They are Not Effective at All

Anxiolytics, Antidepressants and Autogenous training in the therapy of burning mouth syndrome

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