Great boast, small roast on effects of selective serotonin reuptake inhibitors: Response to a critique of our systematic review
Great boast, small roast on effects of selective serotonin reuptake inhibitors: Response to a critique of our systematic review
Abstract
Our systematic review in BMC Psychiatry (see record [rid]2017-06469-001[/rid]) concluded that selective serotonin reuptake inhibitors (SSRIs) compared with placebo significantly increase the risk of serious adverse events (SAEs) in patients with major depression and the potential beneficial effects of SSRIs seem to be outweighed by the harms. Hieronymus et al. accused us of methodological inaccuracies and blatant errors. In their post-hoc analysis of our data, they reported that SSRIs only increase the risk of SAEs in elderly and seems safe for non-elderly patients. They also found our review misleading because our efficacy analyses were based on the 17-item Hamilton Depression Rating Scale; we included suboptimal SSRI doses; and we missed some ‘pivotal trials’. We do not agree with Hieronymus et al. regarding several of the ‘errors’ they claim that we have made. However, we acknowledge that they have identified minor errors and that we missed some trials. After rectifying the errors and inclusion of the missed trials by us and Hieronymus et al., we re-analysed the data. The updated analyses are even more robust and confirm our earlier conclusions. SSRIs significantly increase the risk of an SAE both in non-elderly (p = 0.045) and elderly (p = 0.01) patients [overall odds ratio 1.39; 95% confidence interval (CI) 1.13 to 1.73; p = 0.002; I² = 0%]. Moreover, SSRIs did not change noticeably the 17-item Hamilton Depression Rating Scale, the internationally accepted scale (mean difference −2.02 points; 95% CI −2.38 to −1.66; p < 0.00001). We found no differential effect of dose (p = 0.20). (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Accession Number: 2018-48710-003. PMID: 29465026 Partial author list: First Author & Affiliation: Katakam, Kiran Kumar; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark, kk@ctu.dk. Other Publishers: Blackwell Publishing; Wiley-Blackwell Publishing Ltd. Release Date: 20181011. Publication Type: Journal (0100), Peer Reviewed Journal (0110). Format Covered: Electronic. Document Type: Comment/Reply. Language: English. Major Descriptor: Drug Therapy; Major Depression; Placebo; Serotonin Reuptake Inhibitors. Classification: Clinical Psychopharmacology (3340). References Available: Y. Page Count: 15. Issue Publication Date: Oct, 2018. Publication History: First Posted Date: Feb 21, 2018; Accepted Date: Oct 30, 2017. Copyright Statement: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. Scandinavian College of Neuropsychopharmacology. 2018.
