SSRIs significantly increase the risk of both serious and non-serious adverse events .
The potential small beneficial effects seem to be outweighed by harmful effects .
Background The evidence on selective serotonin reuptake inhibitors ( SSRIs ) for major depressive disorder is unclear .
Methods Our objective was to conduct a systematic review assessing the effects of SSRIs versus placebo , ‘ active ’ placebo , or no intervention in adult participants with major depressive disorder .
Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial.
OBJECTIVE To determine whether supportive-expressive psychotherapy ( SET ) , a form of dynamic psychotherapy , and pharmacotherapy + clinical management ( MED ) for major depressive disorder ( MDD ) are more effective than pill-placebo + clinical management ( PBO ) . METHOD This National Institute of Mental Health (NIMH)-sponsored r and omized controlled trial was conducted ( from November 2001 through June 2007 ) at the University of Pennsylvania Medical School . The sample included 156 patients diagnosed with MDD ( DSM-IV ) and having a 17-item Hamilton Rating Scale for Depression ( HRSD(17 ) ) score ≥ 14 for at least 2 consecutive weeks . This was an underserved sample in which 41 % were male , 52 % were self- design ated minorities , and 76 % had an annual income under $ 30,000 . Treatment lasted 16 weeks . Medication patients not responsive by week 8 ( maximum dose 200 mg/d of sertraline ) were switched to venlafaxine ( maximum dose 375 mg/d ) . Nonresponsive placebo patients at week 8 were switched to a different placebo . RESULTS Patients ' depression improved over the 16 weeks ( P < .0001 ) , with no between-group differences ( P = .95 ) , even among severely ( HRSD(17 ) score ≥ 20 ) depressed patients ( P = .45 ) . Response rates did not differ between groups ( P = .73 ) . Gender and minority status moderated outcome ( P = .014 ) , with psychotherapy more efficacious for minority men than MED ( P = .027 , Cohen d = 1.02 ) and PBO ( P = .019 , d = 1.09 ) . PBO was more efficacious for white men than MED ( P = .03 , d = 0.62 ) and SET ( P = .003 , d = 1.07 ) . For white women , MED ( P = .005 , d = 0.77 ) and SET ( P = .033 , d = 0.71 ) were more efficacious than placebo . No differences among treatments were found for minority women . CONCLUSIONS This trial of urban MDD patients failed to confirm that either active treatment was better than placebo . Minority status and gender had significant and differential effects on outcome that warrant replication in future studies . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00043550
SSRIs significantly increase the risk of both serious and non-serious adverse events .
The potential small beneficial effects seem to be outweighed by harmful effects .
Background The evidence on selective serotonin reuptake inhibitors ( SSRIs ) for major depressive disorder is unclear .
Methods Our objective was to conduct a systematic review assessing the effects of SSRIs versus placebo , ‘ active ’ placebo , or no intervention in adult participants with major depressive disorder .