Citation

Fritze J, Aldenhoff JB, Bergmann F, Maier W, Moller HJ. PsychoNeuro 2005; 31(10): 480-484.

Copyright

(Copyright © 2005)

DOI

10.1055/s-2005-922235

PMID

unavailable

Abstract

The periodical "Arznei-Telegramm" has published a suggestive paper entitled "Antidepressants: Life-threatening Placebos?". This suggests that the efficacy of antidepressants is clinically irrelevant and - because of the possibility of the induction of suicidal phenomena life-threatening. Both is wrong. The apparent effect size demonstrated in meta-analyses of acute trials is flawed essentially by the variable placebo effect. Discontinuation trials probably yield the best estimate of the "true" effect size (23%). Even if the effect size were only 10% this would be highly relevant from the systemic perspective. Actually, there is no evidence for antidepressants increasing the risk of suicide. The possibility can, however, not be excluded that in the initial phase of treatment antidepressants increase the risk of suicidal ideation and suicide attempts, possibly more so SSRIs than other antidepressants. Therefore, patients must be subject to specific awareness in this inital phase. This applies especially for children and adolescents in view of the - due to the particularly high placebo effect - lacking definite proof of efficacy in this age group. Double-blind long-term trials cannot be expected to contribute to further clarification because the suicidal phenomena are rare events typically in the initial phase of treatment. Moreover, such trials would be ethically unacceptable. Instead, pharmacovigilance should focus on these phenomena.

Language: de

Keywords

human; suicide; systematic review; depression; suicide attempt; lithium; clinical trial; risk factor; review; antidepressant agent; serotonin uptake inhibitor; tricyclic antidepressant agent; venlafaxine; psychopharmacology; publication; placebo; medical literature; drug efficacy; meta analysis; research ethics