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Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses

  • Stefan Leucht (a1), Sandra Hierl (a1), Werner Kissling (a1), Markus Dold (a1) and John M. Davis (a2)...
Abstract
Background

The efficacy of psychopharmacological treatments has been called into question. Psychiatrists are unfamiliar with the effectiveness of common medical drugs.

Aims

To put the efficacy of psychiatric drugs into the perspective of that of major medical drugs.

Method

We searched Medline and the Cochrane Library for systematic reviews on the efficacy of drugs compared with placebo for common medical and psychiatric disorders, and systematically presented the effect sizes for primary efficacy outcomes.

Results

We included 94 meta-analyses (48 drugs in 20 medical diseases, 16 drugs in 8 psychiatric disorders). There were some general medical drugs with clearly higher effect sizes than the psychotropic agents, but the psychiatric drugs were not generally less efficacious than other drugs.

Conclusions

Any comparison of different outcomes in different diseases can only serve the purpose of a qualitative perspective. The increment of improvement by drug over placebo must be viewed in the context of the disease's seriousness, suffering induced, natural course, duration, outcomes, adverse events and societal values.

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Copyright
Corresponding author
Professor Stefan Leucht, Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 München, Germany. Email: Stefan.Leucht@lrz.tum.de
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Declaration of interest

In the past 3 years S.L. has received fees for consulting and/or lectures from the following companies: Bristol-Myers Squibb, Actelion, Sanofi-Aventis, Eli Lilly, Essex Pharma, AstraZeneca, MedAvante, Alkermes, Janssen/Johnson & Johnson, Lundbeck Institute and Pfizer, and grant support from Eli Lilly. W.K. has received fees for consulting and/or lectures from Janssen-Cilag, Sanofi-Aventis, Johnson & Johnson, Pfizer, Bristol-Myers Squibb, AstraZeneca, Lundbeck, Novartis and Eli Lilly. All authors work in psychiatry.

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References
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1 Kirsch, I, Deacon, BJ, Huedo-Medina, TB, Scoboria, A, Moore, TJ, Johnson, BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 2008; 5: e45.
2 Kaduszkiewicz, H, Zimmermann, T, Beck-Bornholdt, HP, van den Bussche, H. Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials. BMJ 2005; 331: 321–7.
3 Moncrieff, J. Lithium revisited. A re-examination of the placebo-controlled trials of lithium prophylaxis in manic–depressive disorder. Br J Psychiatry 1995; 167: 569–73.
4 Leucht, S, Arbter, D, Engel, RR, Kissling, W, Davis, JM. How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials. Mol Psychiatry 2009; 14: 429–47.
5 Menand, L. Head case: can psychiatry be a science? The New Yorker 2010; 1 March: 6874.
6 Breggin, P. Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide, and Crime. St Martin's Press, 2008.
7 Kirsch, I. The Emperor's New Drugs: Exploring the Antidepressant Myth. Basic Books, 2010.
8 Herold, G. Innere Medizin. Gerd Herold, 2009.
9 Möller, HJ, Laux, G, Deister, A. Duale Reihe Psychiatrie und Psychotherapie, 4. Auflage. Thieme, 2009.
10 Shea, BJ, Hamel, C, Wells, GA, Bouter, LM, Kristjansson, E, Grimshaw, J, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol 2009; 62: 1013–20.
11 The Nordic Cochrane Centre. Review Manager (RevMan) [Computer program] Version 5.0. Cochrane Collaboration, 2008.
12 Borenstein, M, Hedges, LV, Higgins, JPT, Rothstein, H. Comprehensive Meta-analysis Version 2. Biostat, 2006 (http://www.meta-analysis.com/downloads/Meta-Analysis-Manual.pdf).
13 Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gotzsche, PC, Ioannidis, JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6: e1000100.
14 Chinn, S. A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med 2000; 19: 3127–31.
15 Law, M, Morris, JK, Jordan, R, Wald, N. Headaches and the treatment of blood pressure: results from a meta-analysis of 94 randomized placebo-controlled trials with 24,000 participants. Circulation 2005; 112: 2301–6.
16 Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362: 1527–35.
17 Wardlaw, JM, Murray, V, Berge, E, Del Zoppo, GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2009; 4: CD000213.
18 Hacke, W, Kaste, M, Bluhmki, E, Brozman, M, Davalos, A, Guidetti, D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359: 1317–29.
19 Sandercock, PA, Counsell, C, Gubitz, GJ, Tseng, MC. Antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev 2008; 3: CD000029.
20 Sandercock, PA, Counsell, C, Kamal, AK. Anticoagulants for acute ischaemic stroke. Cochrane Database Syst Rev 2008; 4: CD000024.
21 Baigent, C, Blackwell, L, Collins, R, Emberson, J, Godwin, J, Peto, R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373: 1849–60.
22 Law, MR, Wald, NJ, Rudnicka, AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ 2003; 326: 1423.
23 Baigent, C, Keech, A, Kearney, PM, Blackwell, L, Buck, G, Pollicino, C, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267–78.
24 Garg, R, Yusuf, S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA 1995; 273: 1450–6.
25 Lee, VC, Rhew, DC, Dylan, M, Badamgarav, E, Braunstein, GD, Weingarten, SR. Meta-analysis: angiotensin-receptor blockers in chronic heart failure and high-risk acute myocardial infarction. Ann Intern Med 2004; 141: 693704.
26 Brophy, JM, Joseph, L, Rouleau, JL. Beta-blockers in congestive heart failure. A Bayesian meta-analysis. Ann Intern Med 2001; 134: 550–60.
27 Faris, R, Flather, MD, Purcell, H, Poole-Wilson, PA, Coats, AJ. Diuretics for heart failure. Cochrane Database Syst Rev 2006; 1: CD003838.
28 Hood, WB, Dans, AL, Guyatt, GH, Jaeschke, R, McMurray, JJ. Digitalis for treatment of congestive heart failure in patients in sinus rhythm. Cochrane Database Syst Rev 2004; 2: CD002901.
29 Suarez-Almazor, ME, Belseck, E, Shea, B, Homik, J, Wells, G, Tugwell, P. Antimalarials for treating rheumatoid arthritis. Cochrane Database Syst Rev 2000; 4: CD000959.
30 Blumenauer, B, Judd, M, Wells, G, Burls, A, Cranney, A, Hochberg, M, et al. Infliximab for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev 2002; 3: CD003785.
31 McCrory, DC, Gray, RN. Oral sumatriptan for acute migraine. Cochrane Database Syst Rev 2003; 3: CD002915.
32 Lampl, C, Voelker, M, Diener, HC. Efficacy and safety of 1,000 mg effervescent aspirin: individual patient data meta-analysis of three trials in migraine headache and migraine accompanying symptoms. J Neurol 2007; 254: 705–12.
33 Linde, K, Rossnagel, K. Propranolol for migraine prophylaxis. Cochrane Database Syst Rev 2004; 2: CD003225.
34 Mulleners, WM, Chronicle, EP. Anticonvulsants in migraine prophylaxis: a Cochrane review. Cephalalgia 2008; 28: 585–97.
35 British Thoracic Society. British Guideline on the Management of Asthma. Thorax 2008; 63 (suppl 4): 1121.
36 Sin, DD, Man, J, Sharpe, H, Gan, WQ, Man, SF. Pharmacological management to reduce exacerbations in adults with asthma: a systematic review and meta-analysis. JAMA 2004; 292: 367–76.
37 Ni, CM, Greenstone, IR, Danish, A, Magdolinos, H, Masse, V, Zhang, X, et al. Long-acting beta2-agonists versus placebo in addition to inhaled corticosteroids in children and adults with chronic asthma. Cochrane Database Syst Rev 2005; 4: CD005535.
38 Bateman, E, Nelson, H, Bousquet, J, Kral, K, Sutton, L, Ortega, H, et al. Meta-analysis: effects of adding salmeterol to inhaled corticosteroids on serious asthma-related events. Ann Intern Med 2008; 149: 3342.
39 Salpeter, SR, Buckley, NS, Ormiston, TM, Salpeter, EE. Meta-analysis: effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths. Ann Intern Med 2006; 144: 904–12.
40 Vogelmeier, C, Buhl, R, Criée, CP, Gillissen, A, Kardos, P, Köhler, D, et al. Guidelines for the diagnosis and therapy of COPD issued by Deutsche Atemwegsliga and Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin. Pneumologie 2007; 61: e140.
41 Barr, RG, Bourbeau, J, Camargo, CA, Ram, FS. Tiotropium for stable chronic obstructive pulmonary disease: a meta-analysis. Thorax 2006; 61: 854–62.
42 Yang, IA, Fong, KM, Sim, EH, Black, PN, Lasserson, TJ. Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2007; 2: CD002991.
43 Salpeter, SR, Buckley, NS, Salpeter, EE. Meta-analysis: anticholinergics, but not beta-agonists, reduce severe exacerbations and respiratory mortality in COPD. J Gen Intern Med 2006; 21: 1011–9.
44 Saenz, A, Fernandez-Esteban, I, Mataix, A, Ausejo, M, Roque, M, Moher, D. Metformin monotherapy for type 2 diabetes mellitus. Cochrane Database Syst Rev 2005; 3: CD002966.
45 Van de Laar, FA, Lucassen, PL, Akkermans, RP, Van de Lisdonk, EH, Rutten, GE, van Weel, C. Alpha-glucosidase inhibitors for type 2 diabetes mellitus. Cochrane Database Syst Rev 2005; 2: CD003639.
46 Myers, RP, Regimbeau, C, Thevenot, T, Leroy, V, Mathurin, P, Opolon, P, et al. Interferon for interferon naive patients with chronic hepatitis C. Cochrane Database Syst Rev 2002; 2: CD000370.
47 Brok, J, Gluud, LL, Gluud, C. Ribavirin plus interferon versus interferon for chronic hepatitis C. Cochrane Database Syst Rev 2005; 4: CD005527.
48 Moayyedi, P, Santana, J, Khan, M, Preston, C, Donnellan, C. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev 2007; 2: CD003244.
49 Donnellan, C, Sharma, N, Preston, C, Moayyedi, P. Medical treatments for the maintenance therapy of reflux oesophagitis and endoscopic negative reflux disease. Cochrane Database Syst Rev 2005; 2: CD003245.
50 Sutherland, L, Macdonald, JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev 2006; 2: CD000543.
51 Sutherland, L, Macdonald, JK. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2006; 2: CD000544.
52 Filippini, G, Brusaferri, F, Sibley, WA, Citterio, A, Ciucci, G, Midgard, R, et al. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Cochrane Database Syst Rev 2000; 4: CD001331.
53 Rice, GP, Incorvaia, B, Munari, L, Ebers, G, Polman, C, D'Amico, R, et al. Interferon in relapsing-remitting multiple sclerosis. Cochrane Database Syst Rev 2001; 4: CD002002.
54 National Collaborating Centre for Chronic Conditions. Parkinson's Disease. National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care. Royal College of Physicians, 2006.
55 Fahn, S, Oakes, D, Shoulson, I, Kieburtz, K, Rudolph, A, Lang, A, et al. Levodopa and the progression of Parkinson's disease. N Engl J Med 2004; 351: 2498–508.
56 Early Breast Cancer Trialists' Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 365: 1687–717.
57 Bria, E, Gralla, RJ, Raftopoulos, H, Cuppone, F, Milella, M, Sperduti, I, et al. Magnitude of benefit of adjuvant chemotherapy for non-small cell lung cancer: meta-analysis of randomized clinical trials. Lung Cancer 2009; 63: 50–7.
58 Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. BMJ 1995; 311: 257–63.
59 Young, J, De Sutter, A, Merenstein, D, van Essen, GA, Kaiser, L, Varonen, H, et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet 2008; 371: 908–14.
60 Glasziou, PP, Del Mar, CB, Sanders, SL, Hayem, M. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2004; 1: CD000219.
61 Falagas, ME, Kotsantis, IK, Vouloumanou, EK, Rafailidis, PI. Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials. J Infect 2009; 58: 91102.
62 Nelson, RL, Glenny, AM, Song, F. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 2009; 1: CD001181.
63 Leucht, M, Komossa, K, Heres, S, Kissling, W, Davis, JM. An update on relapse prevention with antipsychotic drugs compared to placebo (abstract). Schizophr Res, in press.
64 Storosum, JG, Wohlfarth, T, Schene, A, Elferink, A, van Zwieten, BJ, van den Brink, W. Magnitude of effect of lithium in short-term efficacy studies of moderate to severe manic episode. Bipolar Disord 2007; 9: 793–8.
65 Smith, LA, Cornelius, V, Warnock, A, Tacchi, MJ, Taylor, D. Pharmacological interventions for acute bipolar mania: a systematic review of randomized placebo-controlled trials. Bipolar Disord 2007; 9: 551–60.
66 Scherk, H, Pajonk, FG, Leucht, S. Second-generation antipsychotic agents in the treatment of acute mania: a systematic review and meta-analysis of randomized controlled trials. Arch Gen Psychiatry 2007; 64: 442–55.
67 Gijsman, HJ, Geddes, JR, Rendell, JM, Nolen, WA, Goodwin, GM. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry 2004; 161: 1537–47.
68 Davis, JM, Janicak, PG, Hogan, DM. Mood stabilizers in the prevention of recurrent affective disorders: a meta-analysis. Acta Psychiatr Scand 1999; 100: 406–17.
69 Geddes, JR, Burgess, S, Hawton, K, Jamison, K, Goodwin, GM. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry 2004; 161: 217–22.
70 Storosum, JG, Elferink, AJ, van Zwieten, BJ, van den Brink, W, Gersons, BP, van Strik, R, et al. Short-term efficacy of tricyclic antidepressants revisited: a meta-analytic study. Eur Neuropsychopharmacol 2001; 11: 173–80.
71 Barbui, C, Furukawa, TA, Cipriani, A. Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. CMAJ 2008; 178: 296305.
72 Geddes, JR, Carney, SM, Davies, C, Furukawa, TA, Kupfer, DJ, Frank, E, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet 2003; 361: 653–61.
73 Hansen, RA, Gartlehner, G, Lohr, KN, Gaynes, BN, Carey, TS. Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder. Ann Intern Med 2005; 143: 415–26.
74 Soomro, GM, Altman, D, Rajagopal, S, Oakley-Browne, M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database Syst Rev 2008; 1: CD001765.
75 Mitte, K. A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. J Affect Disord 2005; 88: 2745.
76 Birks, J. Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database Syst Rev 2006; 1: CD005593.
77 Schachter, HM, Pham, B, King, J, Langford, S, Moher, D. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. CMAJ 2001; 165: 1475–88.
78 Faraone, SV, Biederman, J. Efficacy of Adderall for attention-deficit/hyperactivity disorder: a meta-analysis. J Atten Disord 2002; 6: 6975.
79 Cheng, JY, Chen, RY, Ko, JS, Ng, EM. Efficacy and safety of atomoxetine for attention-deficit/hyperactivity disorder in children and adolescents – meta-analysis and meta-regression analysis. Psychopharmacology (Berl) 2007; 194: 197209.
80 Nelson, HS, Weiss, ST, Bleecker, ER, Yancey, SW, Dorinsky, PM. The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest 2006; 129: 1526.
81 The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in Type 2 diabetes. N Engl J Med 2008; 358: 2545–59.
82 Leucht, S, Davis, JM, Engel, RR, Kane, JM, Wagenpfeil, S. Defining ‘response’ in antipsychotic drug trials: recommendations for the use of scale-derived cutoffs. Neuropsychopharmacology 2007; 32: 1903–10.
83 Baldessarini, RJ, Tondo, L, Hennen, J. Lithium treatment and suicide risk in major affective disorders: update and new findings. J Clin Psychiatry 2003; 64 (suppl 5): 4452.
84 Cipriani, A, Pretty, H, Hawton, K, Geddes, JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry 2005; 162: 1805–19.
85 Furukawa, TA, Watanabe, N, Omori, IM, Montori, VM, Guyatt, GH. Association between unreported outcomes and effect size estimates in Cochrane meta-analyses. JAMA 2007; 297: 468–70.
86 Covey, J. A meta-analysis of the effects of presenting treatment benefits in different formats. Med Decis Making 2007; 27: 638–54.
87 Cohen, J. Statistical Power Analysis for the Behavioral Sciences (second edition). Erlbaum, 1988.
88 Schlander, M. Measures of efficiency in healthcare: QALMs about QALYs. Z Evid Fortbild Qual Gesundhwes 2010; 104: 214–26.
89 Griebsch, I, Coast, J, Brown, J. Quality-adjusted life-years lack quality in pediatric care: a critical review of published cost-utility studies in child health. Pediatrics 2005; 115: e60014.
90 Trikalinos, TA, Churchill, R, Ferri, M, Leucht, S, Tuunainen, A, Wahlbeck, K, et al. Effect sizes in cumulative meta-analyses of mental health randomized trials evolved over time. J Clin Epidemiol 2004; 57: 1124–30.
91 Davis, JM, Wang, Z, Janicak, PG. A quantitative analysis of clinical drug trials for the treatment of affective disorders. Psychopharmacol Bull 1993; 29: 175–81.
92 Cole, JO. Phenothiazine treatment in acute schizophrenia. Arch Gen Psychiatry 1964; 10: 246–61.
93 Clomipramine Collaborative Study Group. Clomipramine in the treatment of patients with obsessive–compulsive disorder. Arch Gen Psychiatry 1991; 48: 730–8.
94 Ackerman, DL, Greenland, S. Multivariate meta-analysis of controlled drug studies for obsessive-compulsive disorder. J Clin Psychopharmacol 2002; 22: 309–17.
95 Walsh, BT, Seidman, SN, Sysko, R, Gould, M. Placebo response in studies of major depression: variable, substantial, and growing. JAMA 2002; 287: 1840–7.
96 Turner, EH, Matthews, AM, Linardatos, E, Tell, RA, Rosenthal, R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008; 358: 252–60.
97 Rising, K, Bacchetti, P, Bero, L. Reporting bias in drug trials submitted to the Food and Drug Administration: review of publication and presentation. PLoS Med 2008; 5: e217.
98 Flather, MD, Yusuf, S, Kober, L, Pfeffer, M, Hall, A, Murray, G, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet 2000; 355: 1575–81.
99 Suarez-Almazor, ME, Belseck, E, Shea, B, Wells, G, Tugwell, P. Methotrexate for rheumatoid arthritis. Cochrane Database Syst Rev 2000; 2: CD000957.
100 Macritchie, KA, Geddes, JR, Scott, J, Haslam, DR, Goodwin, GM. Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev 2001; 3: CD003196.
101 Bech, P, Cialdella, P, Haugh, MC, Hours, A, Boissel, JP, Birkett, MA, et al. Meta-analysis of randomised controlled trials of fluoxetine v. placebo and tricyclic antidepressants in the short-term treatment of major depression. Br J Psychiatry 2000; 176: 421–8.
102 Hansen, R, Gaynes, B, Thieda, P, Gartlehner, G, Veaugh-Geiss, A, Krebs, E, et al. Meta-analysis of major depressive disorder relapse and recurrence with second-generation antidepressants. Psychiatr Serv 2008; 59: 1121–30.
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Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses

  • Stefan Leucht (a1), Sandra Hierl (a1), Werner Kissling (a1), Markus Dold (a1) and John M. Davis (a2)...
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eLetters

Choice of outcome measures

Andrew Shepherd, Psychiatry Trainee
08 February 2012

In their review Leucht and colleagues provide a reassuring view of the efficacy of psychotropics, in comparison to medical treatments (1).

Their discussion raises the issue of 'soft' outcomes in psychiatry incomparison to other disciplines. They compare diagnoses such as Schizophrenia to other diseases causing suffering, such as Migraine, stating that reduction in disease severity and preventing future relapse are therefore the most appropriate measures. The diagnosis of Schizophrenia, and other mental disorders, requires an impact on the individuals social or occupational functioning, and it is this change thatwill have the greatest impact on patients and their families, so while reducing relapse is undoubtedly an important measure, we could also consider the impact from individual episodes. Discussion in other disciplines has recently focussed on the issues of using surrogate measures to chart disease progression (2), and other means, including patient reported impact on quality of life have been used to compare outcomes (3).

The impact of mental illness on quality of life is clear, and can be assessed (4), and while generic measures such as the EQ-5D are of questionable validity in psychiatry, this does not undermine the importance of developing such measures, and attempting to correlate them with our existing disease severity measures (5).

Disease severity measures within individual domains may be included within DSM-5, and it will be interesting to see the impact of their assessment. However, impact on quality of life are likely what our patients will care about most in discussing and planning their treatment options, is it not therefore advisable that we develop reliable measures, and insist on their use as the primary outcome measure in clinical trials?

(1) Leucht, S. et al. Putting the efficacy of psychiatric and generalmedicine medication into perspective: review of meta-analyses. The BritishJournal of Psychiatry, 2012 200(2), pp.97-106.

(2) Yudkin, J.S., Lipska, K.J. & Montori, V.M.,. The idolatry of the surrogate. BMJ, 2011 343, p.d7995.

(3) Appleby, J. Patient reported outcome measures: how are we feelingtoday? BMJ 2011 343:d8191 doi: 10.1136/bmj.d8191

(4) Saarni, S.I. et al.,. Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders. The BritishJournal of Psychiatry, 2010 197(5), pp.386-394.

(5) Brazier, J. Is the EQ-5D fit for purpose in mental health? The British Journal of Psychiatry, 2010 197(5), pp.348-349.

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Conflict of interest: None declared

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