We were asked to write a reply to the Ioannidis’s paper
“Effectiveness of antidepressants; an evidence based
myth constructed from a thousand controlled trials,” a
critique extended to behavioral and psychotherapies, as
well [1]. However, after agreeing to this task, we realized
that the paper was an excellently written paper and that
we agreed with most of Ioannidis’s points and except
one point: his statement that both antidepressants and
psychotherapeutic/behavioral treatments have no efficacy.
A brief summary of Ioannidis’s paper is as follows:
Ioannidis says that antidepressant use is based on
“pseudo-evidence-based medicine” and that there is “no
reason to take antidepressants.” He characterizes antidepressant
effectiveness as a “myth” that is misleading the
public into believing that this class of medicine is useful,
and he builds his argument along several lines. Ioannidis
quotes evidence that drug companies fail to publish some
clinical trials, often trials where their drugs are not found
to be as effective as they desire. He argues that the effect
size of antidepressants is small, and would be even smaller
if many negative trials were published. He describes methodological
problems with clinical trials of antidepressants