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Should We Treat Depression with drugs or psychological interventions? A Reply to Ioannidis

Overview of attention for article published in Philosophy, Ethics, and Humanities in Medicine, January 2011
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  • Good Attention Score compared to outputs of the same age (73rd percentile)

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1 Google+ user


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Should We Treat Depression with drugs or psychological interventions? A Reply to Ioannidis
Published in
Philosophy, Ethics, and Humanities in Medicine, January 2011
DOI 10.1186/1747-5341-6-8
Pubmed ID

John M Davis, William J Giakas, Jie Qu, Pavan Prasad, Stefan Leucht


We reply to the Ioannidis's paper "Effectiveness of antidepressants; an evidence based myth constructed from a thousand controlled trials." We disagree that antidepressants have no greater efficacy than placebo. We present the efficacy from hundreds of trials in terms of the percentage of patients with a substantial clinical response (a 50% improvement or more symptomatic reduction). This meta-analysis finds that 42-70% of depressed patients improve with drug and 21%-39% improve with placebo. The response benefit of antidepressant treatment is 33%-11% greater than placebo. Ioannidis argues that it would be vanishingly smaller because systematic biasing in these clinical trials would reduce the drug-placebo difference to zero. Ioannidis' argument that antidepressants have no benefit is eroded by his failures of logic because he does not present any evidence that there are a large number of studies where placebo is substantially more effective than drug. (To reduce to zero, one would also have to show that some of the unpublished studies find placebo better than drug and have substantial systematic or methodological bias). We also present the empirical evidence showing that these methodological concerns generally have the opposite effect of what Ioannidis argues, supporting our contention that the measured efficacy of antidepressants likely underestimates true efficacy. Our most important criticism is Ioannidis' basic underlying argument about antidepressants that if the existing evidence is imperfect and methods can be criticized, then this proves that antidepressant are not efficacious. He presents no credible evidence that antidepressants have zero effect size. Valid arguments can point out difficulties with the data but do not prove that a given drug had no efficacy. Indeed better evidence might prove it was more efficacious that originally found. We find no empirical or ethical reason why psychiatrists should not try to help depressed patients with drugs and/or with psychotherapeutic/behavioral treatments given evidence of efficacy even though our treatment knowledge has limitations. The immense suffering of patients with major depression leads to ethical, moral, professional and legal obligations to treat patients with the best available tools at our disposal, while diligently and actively monitoring for adverse effects and actively revising treatment components as necessary.

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Mendeley readers

The data shown below were compiled from readership statistics for 59 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 2%
Norway 1 2%
Unknown 57 97%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 10 17%
Student > Master 10 17%
Researcher 8 14%
Student > Doctoral Student 6 10%
Other 6 10%
Other 15 25%
Unknown 4 7%
Readers by discipline Count As %
Psychology 20 34%
Medicine and Dentistry 18 31%
Neuroscience 5 8%
Social Sciences 4 7%
Philosophy 2 3%
Other 6 10%
Unknown 4 7%

Attention Score in Context

This research output has an Altmetric Attention Score of 4. 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 13 February 2020.
All research outputs
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Outputs from Philosophy, Ethics, and Humanities in Medicine
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Outputs of similar age
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Outputs of similar age from Philosophy, Ethics, and Humanities in Medicine
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Altmetric has tracked 16,948,032 research outputs across all sources so far. This one has received more attention than most of these and is in the 71st percentile.
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 is in the 34th percentile – i.e., 34% of its peers scored the same or lower than it.
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 221,898 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 73% of its contemporaries.
We're also able to compare this research output to 14 others from the same source and published within six weeks on either side of this one. This one is in the 7th percentile – i.e., 7% of its contemporaries scored the same or lower than it.