↓ Skip to main content

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Overview of attention for article published in Philosophy, Ethics, and Humanities in Medicine, January 2008
Altmetric Badge

About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • One of the highest-scoring outputs from this source (#3 of 199)
  • High Attention Score compared to outputs of the same age (99th percentile)
  • High Attention Score compared to outputs of the same age and source (98th percentile)

Mentioned by

news
5 news outlets
blogs
7 blogs
policy
1 policy source
twitter
93 tweeters
facebook
9 Facebook pages
wikipedia
2 Wikipedia pages
googleplus
3 Google+ users
reddit
3 Redditors
video
2 video uploaders

Citations

dimensions_citation
150 Dimensions

Readers on

mendeley
250 Mendeley
citeulike
1 CiteULike
Title
Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?
Published in
Philosophy, Ethics, and Humanities in Medicine, January 2008
DOI 10.1186/1747-5341-3-14
Pubmed ID
Authors

John PA Ioannidis

Abstract

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.

Twitter Demographics

The data shown below were collected from the profiles of 93 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 250 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 3 1%
Spain 2 <1%
Brazil 1 <1%
Hong Kong 1 <1%
Italy 1 <1%
South Africa 1 <1%
Norway 1 <1%
Germany 1 <1%
United States 1 <1%
Other 0 0%
Unknown 238 95%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 34 14%
Student > Ph. D. Student 34 14%
Researcher 31 12%
Student > Master 27 11%
Other 22 9%
Other 76 30%
Unknown 26 10%
Readers by discipline Count As %
Medicine and Dentistry 95 38%
Psychology 53 21%
Neuroscience 13 5%
Social Sciences 13 5%
Agricultural and Biological Sciences 10 4%
Other 32 13%
Unknown 34 14%

Attention Score in Context

This research output has an Altmetric Attention Score of 165. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 28 December 2020.
All research outputs
#130,730
of 17,094,905 outputs
Outputs from Philosophy, Ethics, and Humanities in Medicine
#3
of 199 outputs
Outputs of similar age
#125,800
of 15,938,844 outputs
Outputs of similar age from Philosophy, Ethics, and Humanities in Medicine
#3
of 199 outputs
Altmetric has tracked 17,094,905 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 199 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 13.3. This one has done particularly well, scoring higher than 98% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 15,938,844 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 199 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 98% of its contemporaries.