Do not blame the SSRIs: blame the Hamilton Depression Rating Scale

Østergaard, Søren Dinesen

doi:10.1017/neu.2017.6

Cited by 22 publications

(17 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this letter, we have focussed on methodological problems related to how the authors have analysed the alleged association between SSRIs and SAEs but refrained from discussing the issue of efficacy since the conclusions drawn in the Jakobsen paper in this regard are neither novel nor controversial: that SSRIs do outperform placebo, but that the difference between groups appears small when the effect is assessed using the sum score of the Hamilton Depression Rating Scale (HDRS), is hence in line with several previous meta-analyses. We, however, agree with Østergaard (41), who in a previous letter to this journal pointed out that the well-documented and well-argued shortcomings of the total rating of all 17 HDRS items as a measure of the antidepressant effect of SSRIs, disclosed, for example, by Per Bech et al (for refs see 41), renders studies based on this parameter, including that of Jakobsen et al, grossly misleading.…”

supporting

confidence: 82%

Multiple possible inaccuracies cast doubt on a recent report suggesting selective serotonin reuptake inhibitors to be toxic and ineffective

Hieronymus

Lisinski

Näslund

et al. 2017

Acta Neuropsychiatr.

View full text Add to dashboard Cite

According to a systematic review on the use of selective serotonin reuptake inhibitors (SSRIs) in adult depression that was recently published in BMC Psychiatry, the results of which have been widely disseminated in lay media, these drugs increase the risk for serious adverse events (SAEs) while exerting poor antidepressant efficacy. A cursory analysis, however, suggests the analysis of SAEs conducted by the authors to be marred by both methodological inaccuracies and blatant errors. After having corrected for these apparent mistakes, we conducted a sensitivity analysis in which we also accounted for a possible moderating effect of age; while this suggests SSRIs to be safe drugs in the non-elderly, they do confirm what is already known, that is, that they may enhance the risk for SAEs in the old. Given the loose definition of SAE, including also innocuous phenomena, the possible clinical significance of the latter observation, however, remains unclear until the nature and actual impact of the SAEs in question have been clarified. Moreover, with respect to efficacy, we find the paper in BMC Psychiatry misleading: first, the authors seem unaware of the well-established shortcomings associated with the conventional efficacy parameter on which their analysis is based, second, they have included suboptimal SSRI doses and third, they have missed some pivotal trials. Unless there are explanations for the many peculiarities in this paper that have escaped us, and which may be satisfactorily clarified by the authors, it seems important that the conclusions presented in this paper be publicly rectified.

show abstract

supporting

confidence: 82%

Multiple possible inaccuracies cast doubt on a recent report suggesting selective serotonin reuptake inhibitors to be toxic and ineffective

Hieronymus

Lisinski

Näslund

et al. 2017

Acta Neuropsychiatr.

View full text Add to dashboard Cite

show abstract

“…Notably, when items in a rating scale intended to measure psychopathology are affected by side‐effects of a treatment, it reduces the sensitivity of the rating scale to the treatment's effect on the core clinical syndrome being targeted by the treatment . This is a well‐known phenomenon in depression, where the most widely used rating scale, the 17‐item Hamilton Depression Rating Scale (HAM‐D 17 ) is biased against the antidepressant effect of selective serotonin reuptake inhibitors, while the 6‐item melancholia subscale (HAM‐D 6 ) of HAM‐D 17 is not . This difference is due to the fact that the HAM‐D 17 items ‘somatic symptoms – gastrointestinal’, ‘genital symptoms’ and ‘loss of weight’ tap into some of the most common side‐effects of SSRIs, namely diarrhoea/constipation/nausea, loss of libido/erectile dysfunction/anorgasmia, and loss of appetite [40].…”

Section: Discussionmentioning

confidence: 99%

The validity and sensitivity of PANSS‐6 in treatment‐resistant schizophrenia

Østergaard

Foldager

Mors

et al. 2018

Acta Psychiatr Scand

View full text Add to dashboard Cite

show abstract

“… By applying the best‐fitting model found in the primary analyses to the two further trials to ascertain whether the findings were replicable. By including only measurement time points at which all studies reported the outcomes. By excluding studies in which we converted MADRS scores into HRSD scores. By using 6‐item HRSD which has been shown to be more sensitive to change than 17‐item HRSD …”

Section: Methodsmentioning

confidence: 99%