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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)...



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


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


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.


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.


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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Corresponding author

Professor Stefan Leucht, Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 München, Germany. Email:


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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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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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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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