Psychol Med. 2010 Feb;40(2):181-6. doi: 10.1017/S0033291709006102.
Two recent meta-analyses on second-generation antidepressants versus placebo in mild to moderate forms of major depression, based on data on all randomized clinical trials using the Hamilton Depression Scale (HAMD) submitted to FDA, have shown an effect size of approximately 0.30 in favour of antidepressants in the acute therapy of major depression. The clinical significance of an effect size at this level was found to be so poor that these meta-analyses have subscribed to the myth of an exclusively placebo-like effect of second-generation antidepressants. A re-allocation of HAMD items focusing on those items measuring severity of clinical depression, the HAMD6, has identified effect sizes of >or=0.40 for second-generation antidepressants in placebo-controlled trials for which even a dose-response relationship can be demonstrated. In the relapse-prevention phase during continuation therapy of patients with major depression, the advantage of second-generation antidepressants over placebo was as significant as in the acute therapy phase. To explore a myth is not to deny the facts but rather to re-allocate them.
最近有两项针对第二代抗抑郁药与安慰剂在轻至中度重度抑郁症中的疗效的荟萃分析，这些分析基于所有向 FDA 提交的使用汉密尔顿抑郁量表 (HAMD) 的随机临床试验数据，结果显示在重度抑郁症的急性治疗中，抗抑郁药的疗效约为 0.30。研究发现，这种水平的疗效大小非常差，以至于这些荟萃分析都认为第二代抗抑郁药只有安慰剂样的效果。重新分配侧重于测量临床抑郁严重程度的 HAMD 项目（HAMD6），结果表明，在安慰剂对照试验中，第二代抗抑郁药的疗效大小大于等于 0.40，甚至可以证明剂量反应关系。在重度抑郁症患者的继续治疗的复发预防阶段，第二代抗抑郁药相对于安慰剂的优势与急性治疗阶段一样显著。探索一个神话并不是要否认事实，而是要重新分配它们。
