Division of Psychiatry,University College London,London,UK.
Epidemiol Psychiatr Sci. 2018 Oct;27(5):430-432. doi: 10.1017/S2045796018000240. Epub 2018 May 28.
A recent meta-analysis of antidepressant trials is the largest conducted to date. Although it claims to prove antidepressant effectiveness beyond dispute, the main outcome is response rates, which are derived from continuous data in a process that can inflate differences between groups. The standardised mean difference of 0.3 is in line with other meta-analyses that show small differences between antidepressants and placebo that are unlikely to be clinically significant. Other factors likely to exaggerate the effects are discussed, and evidence on associations between antidepressant effects and severity and outcomes of long-term treatment is considered. Clinicians need to have open discussions with patients about the limitations of antidepressant research, the lack of evidence that antidepressants correct a chemical imbalance or other brain abnormality, and the range of adverse effects and mental and physical alterations they can produce.
最近一项抗抑郁药物试验的荟萃分析是迄今为止规模最大的一次。尽管它声称无可争议地证明了抗抑郁药物的有效性，但主要结果是反应率，这是从连续数据中得出的，这一过程可能会夸大组间差异。0.3 的标准化均数差与其他荟萃分析一致，表明抗抑郁药与安慰剂之间的差异很小，不太可能具有临床意义。还讨论了可能夸大这些效果的其他因素，并考虑了抗抑郁药效果与长期治疗的严重程度和结果之间的关联证据。临床医生需要与患者进行开诚布公的讨论，讨论抗抑郁药研究的局限性、缺乏证据表明抗抑郁药纠正化学失衡或其他大脑异常、以及它们可能产生的一系列不良反应和身心改变。
