Antidepressant Trials Need Radical Methodology Reform
Journal of Psychiatry Reform Vol 9 #17. November 15, 2022
Alan Eppel MB, MRCPsych, FRCPC
The author has no conflicts of interest.
In this edition of the journal we have reprinted a Danish Cochrane reanalysis of a meta-analysis conducted by Cipriani et al . The original meta-analysis was carried out over many years and was exhaustive in scope . However the results of the analysis were questioned on the basis of methodology and potential bias .
The reanalysis by Munkholm et al illustrates the complexity of current methodologies and the difficulty in appraising the validity of study findings. The authors assessed multiple variables including trial duration, selective outcome reporting, relevance of clinical outcome measures, clinical versus statistical significance of results, and certainty of evidence.
The authors concluded that the Cipriani study should not inform clinical practice. They stressed the need for “radical change in the way antidepressant trials are being conducted reported and interpreted”.
In order to get more relevant and reliable outcomes the authors recommend “large-scale, industry-independent and better blinded, long-term trials of drug naïve participants, with patient-relevant outcomes rather than ranking scales”.
These conclusions have widespread importance in psychiatry and should be kept in mind when appraising the psychiatric research literature.
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