Umoya05

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?
Source: Philosophy, Ethics, and Humanities in Medicine

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of “positive” trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. “Negative” trials were either left unpublished or were distorted to present “positive” results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.

+ Full Paper (PDF; 204 KB)

Parent-Reported Sleep Problems During Development and Self-reported Anxiety/Depression, Attention Problems, and Aggressive Behavior Later in Life
Source: Archives of Pediatrics & Adolescent Medicine

Sleep problems are risk indicators of later emotional difficulties in childhood and adolescence and in adulthood, as well as across these developmental periods. Although most research, to date, has focused on symptoms of insomnia in association with emotional difficulties, there is emerging evidence that other sleep and sleep-related problems (referred to herein as sleep problems) may also be linked to subsequent difficulties that are not only emotional but also behavioral. Indeed, results of one study demonstrated that a composite of different sleep problems predicted symptoms of anxiety and depression, attention problems, and aggression later in life. For knowledge concerning links between sleep problems and later emotional and behavioral difficulties to be maximally beneficial to the physician, clarification of which particular sleep problems are associated with later difficulties is paramount. Toward this aim, this article documents associations between parental perceptions of 6 aspects of sleep (examined during development) and subsequent self-reported emotional and behavioral difficulties in a representative sample of 2076 participants from Zuid-Holland. This study is novel in allowing comparison of different types of sleep problems as predictors of different types of later behavioral and emotional problems. Based on previous research, associations between different aspects of sleep and different types of emotional and behavioral problems were expected, but hypotheses concerning specific patterns of association were considered premature.

Misery is not Miserly: Sad and Self-Focused Individuals Spend More (PDF; 236 KB)
Source: Society for Personality and Social Psychology (annual meeting)
From press release (National Science Foundation):

Off to buy a new handbag and fabulous red shoes, or how about overalls and a riding lawnmower? Before going, a mood check for signs of despair and gloom might be in order because how a person feels can impact routine economic transactions, whether he or she is aware of it or not.

So says a team of behavioral scientists from four major U.S. universities, whose research study finds that sadness impacts spending. Specifically, people who feel sad and self-focused pay more money for goods than those in neutral states, even when purchasing the same item.

“The tendency is to focus on oneself when sad drives this effect,” says the study’s lead author Cynthia E. Cryder, a doctoral student at Carnegie Mellon University, Pittsburgh, Pa. “Our studies revealed the more self-focused people were in the sad condition, the more money they spent.”