1 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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