Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis

BMC Psychiatry, Journal Year: 2017, Volume and Issue: 17(1)

Published: Feb. 8, 2017

The evidence on selective serotonin reuptake inhibitors (SSRIs) for major depressive disorder is unclear. Our objective was to conduct a systematic review assessing the effects of SSRIs versus placebo, ‘active’ or no intervention in adult participants with disorder. We searched eligible randomised clinical trials Cochrane Library’s CENTRAL, PubMed, EMBASE, PsycLIT, PsycINFO, Science Citation Index Expanded, trial registers Europe and USA, websites pharmaceutical companies, U.S. Food Drug Administration (FDA), European Medicines Agency until January 2016. All data were extracted by at least two independent investigators. used methodology, Trial Sequential Analysis, calculation Bayes factor. An eight-step procedure followed assess if thresholds statistical significance crossed. Primary outcomes reduction symptoms, remission, adverse events. Secondary suicides, suicide attempts, ideation, quality life. A total 131 placebo-controlled enrolling 27,422 included. None placebo as control intervention. had high risk bias. significantly reduced Hamilton Depression Rating Scale (HDRS) end treatment (mean difference −1.94 HDRS points; 95% CI −2.50 −1.37; P < 0.00001; 49 trials; Analysis-adjusted −2.70 −1.18); factor below predefined threshold (2.01*10−23). effect estimate, however, our 3 points. decreased remission (RR 0.88; 0.84 0.91; 34 Analysis adjusted 0.83 0.92); (1426.81) did not confirm effect). increased risks serious events (OR 1.37; 1.08 1.75; = 0.009; 44 1.03 1.89). This corresponds 31/1000 SSRI will experience event compared 22/1000 participants. also number non-serious There almost suicidal behaviour, life, long-term effects. might have statistically significant but all bias seems questionable. increase both potential small beneficial seem be outweighed harmful PROSPERO CRD42013004420.

Language: Английский

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Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies

Alcohol and Alcoholism, Journal Year: 2013, Volume and Issue: 48(5), P. 570 - 578

Published: July 19, 2013

Aims: The aim of the study was to investigate efficacy and safety as-needed use nalmefene 18 mg versus placebo in reducing alcohol consumption patients who did not reduce their after an initial assessment, i.e. pooled subgroup with at least a high drinking risk level (men: >60 g/day; women: >40 g/day) both screening randomization from two randomized controlled 6-month studies ESENSE 1 (NCT00811720) 2 (NCT00812461). Methods: Nalmefene were taken on basis. All also received motivational adherence-enhancing intervention (BRENDA). co-primary outcomes number heavy days (HDDs) mean total (g/day) Month 6 measured using Timeline Follow-back method. Additionally, data clinical improvement, liver function collected throughout study. Results: population consisted 667 patients: n = 332; 335. There superior effect compared HDDs [treatment difference: −3.2 (95% CI: −4.8; −1.6); P < 0.0001] −14.3 g/day (−20.8; −7.8); 6. Improvements status parameters greater group group. Adverse events adverse leading dropout more common than placebo. Conclusion: As-needed efficacious randomization, this larger population.

Language: Английский

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The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(1), P. 133 - 145

Published: Jan. 11, 2022

Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such waiting list). We performed an umbrella review recent meta-analyses randomized controlled (RCTs) psychotherapies for the main mental adults. selected formally assessed risk bias or quality studies, excluded comparators, used effect sizes target symptoms primary outcome. searched PubMed PsycINFO individual records Cochrane Library published between January 2014 March 2021 comparing with placebo treatment-as-usual (TAU), vs. head-to-head, combination psychotherapy pharmacotherapy either monotherapy. One hundred two meta-analyses, encompassing 3,782 RCTs 650,514 patients, were included, covering depressive disorders, anxiety post-traumatic stress disorder, obsessive-compulsive somatoform eating attention-deficit/hyperactivity substance use insomnia, schizophrenia spectrum bipolar disorder. Across treatments, majority small. A random meta-analytic evaluation reported by largest per disorder yielded standardized mean difference (SMD) 0.34 (95% CI: 0.26-0.42) 0.36 0.32-0.41) compared TAU. The SMD head-to-head comparisons was 0.11 -0.05 0.26). combined treatment monotherapy 0.31 0.19-0.44). Risk often high. After more than half century research, thousands millions invested funds, limited, suggesting ceiling research presently conducted. paradigm shift seems required achieve further progress.

Language: Английский

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Efficacy of Pharmacotherapy and Psychotherapy for Adult Psychiatric Disorders

JAMA Psychiatry, Journal Year: 2014, Volume and Issue: 71(6), P. 706 - 706

Published: April 30, 2014

Importance

There is debate about the effectiveness of psychiatric treatments and whether pharmacotherapy or psychotherapy should be primarily used.

Objectives

To perform a systematic overview on efficacy pharmacotherapies psychotherapies for major disorders to compare quality trials.

Evidence Review

We searched MEDLINE, EMBASE, PsycINFO, Cochrane Library (April 2012, with no time language limit) reviews vs placebo, psychotherapy, their combination either modality alone. Two reviewers independently selected meta-analyses extracted effect sizes. assessed individual trials included in risk bias tool.

Findings

The search yielded 45 233 results. 61 21 disorders, which contained 852 137 126 participants. mean size was medium (mean, 0.50; 95% CI, 0.41-0.59). Effect sizes placebo tended higher than those medication, but direct comparisons, albeit usually based few trials, did not reveal consistent differences. Individual were more likely have large sample sizes, blinding, control groups, intention-to-treat analyses. In contrast, had lower dropout rates provided follow-up data. studies, wait-list designs showed larger effects comparisons placebo.

Conclusions Relevance

Many are effective, there lot room improvement. Because multiple differences methods used indirect compared treatment problematic. Well-designed scarce, need public funding. patients often benefit from both forms therapy, research also focus how modalities can best combined maximize synergy rather use one over other.

Language: Английский

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Time for united action on depression: a Lancet–World Psychiatric Association Commission

The Lancet, Journal Year: 2022, Volume and Issue: 399(10328), P. 957 - 1022

Published: Feb. 15, 2022

Language: Английский

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Pharmacologic Treatment of Attention Deficit–Hyperactivity Disorder

New England Journal of Medicine, Journal Year: 2020, Volume and Issue: 383(11), P. 1050 - 1056

Published: Sept. 9, 2020

Amphetamines and methylphenidate and, less often, nonstimulants (atomoxetine, clonidine, guanfacine) are used to treat ADHD. Inattentiveness restlessness improved more than quality-of-life measures in short-term trials.

Language: Английский

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Early Intervention in Psychosis

The Journal of Nervous and Mental Disease, Journal Year: 2015, Volume and Issue: 203(5), P. 310 - 318

Published: April 28, 2015

Early intervention for potentially serious disorder is a fundamental feature of healthcare across the spectrum physical illness. It has been major factor in reductions morbidity and mortality that have achieved some non-communicable diseases, notably cancer cardiovascular disease. Over past two decades, an international collaborative effort mounted to build evidence capacity early psychotic disorders, schizophrenia, where so long deep pessimism had reigned. The origins rapid development psychosis are described from personal Australian perspective. This uniquely evidence-informed, evidence-building cost-effective reform provides blueprint launch pad radically change wider landscape mental health care dissolve many barriers constrained progress long.

Language: Английский

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Treatment strategies for ADHD: an evidence-based guide to select optimal treatment

Molecular Psychiatry, Journal Year: 2018, Volume and Issue: 24(3), P. 390 - 408

Published: June 28, 2018

Language: Английский

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Post-traumatic stress disorder

BMJ, Journal Year: 2015, Volume and Issue: unknown, P. h6161 - h6161

Published: Nov. 26, 2015

Language: Английский

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What do citation counts measure? An updated review of studies on citations in scientific documents published between 2006 and 2018

Scientometrics, Journal Year: 2019, Volume and Issue: 121(3), P. 1635 - 1684

Published: Sept. 28, 2019

Language: Английский

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