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EXAMINING ANTIDEPRESSANT
EFFECTIVENESS:
FINDINGS, AMBIGUITIES,
AND SOME VEXING PUZZLES
Roger P. Greenberg Seymour Fisher State University of New YorkHealth Science CenterSince Kuhn ( 1958) detected an apparent antidepressant effect for imipramine,
many studies have explored this phenomenon. Despite some past skeptical
opinions ( Jenner, 1977; Porter, 1970; Wechsler, Grosser, & Greenblatt,
1965), it is now widely accepted that the therapeutic effectiveness of the
antidepressants, especially the tricyclics, has been indubitably demonstrated.
However, although this chapter does not question that antidepressants are
therapeutic, it does question the magnitude of the effect and some of its
underlying causes. As we surveyed the literature dealing with antidepressants,
we detected some inconsistences and methodological gaps in current claims
and clinical practices. The history of treatment modes for psychological
disturbance bristles with examples (e.g., insulin therapy, lobotomy) that were
widely accepted and ultimately proved to fall short of early claims. This is, of
course, also true in other areas of treatment ( Benson & McCallie, 1979). A
cautious attitude about treatment claims is dictated by what has gone before.
Among other things, this chapter focuses on the way in which the double-
blind design has typically been used to evaluate the therapeutic value of the
antidepressants and suggests that it has not been applied satisfactorily. More
specifically, our intent is the following:
1. To appraise the effectiveness of the antidepressants across multiple
reviews and studies. It should be noted, however, that the appraisal restricts
itself to the effectiveness for relieving depression and does not deal with other
symptom categories to which antidepressants have been applied.
2. To examine the stability of findings involving the antidepressants, with

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Publication Information: Book Title: The Limits of Biological Treatments for Psychological Distress: Comparisons with Psychotherapy and Placebo. Contributors: Seymour Fisher - editor, Roger P. Greenberg - editor. Publisher: Lawrence Erlbaum Associates. Place of Publication: Hillsdale, NJ. Publication Year: 1989. Page Number: 1.
    
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