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Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses
Open accessAbstract
Background: The efficacy of psychopharmacological treatments has been called into question. Psychiatrists are unfamiliar with the effectiveness of common medical drugs. Aims: To put the efficacy of psychiatric drugs into the perspective of that of major medical drugs. Method: We searched Medline and the Cochrane Library for systematic reviews on the efficacy of drugs compared with placebo for common medical and psychiatric disorders, and systematically presented the effect sizes for primary efficacy outcomes. Results: We included 94 meta-analyses (48 drugs in 20 medical diseases, 16 drugs in 8 psychiatric disorders). There were some general medical drugs with clearly higher effect sizes than the psychotropic agents, but the psychiatric drugs were not generally less efficacious than other drugs. Conclusions: Any comparison of different outcomes in different diseases can only serve the purpose of a qualitative perspective. The increment of improvement by drug over placebo must be viewed in the context of the disease's seriousness, suffering induced, natural course, duration, outcomes, adverse events and societal values.
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“These medications, which are as efficacious, or more efficacious, than many medications used for non-psychiatric disorders (Leucht et al., 2012)”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Leucht et al., 2012
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BackgroundEarly Intervention in Psychosis
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“…reform (J Nerv Ment Dis 2015;203: 310–318) A lthough the efficacy of modern treatments in psychiatry is compa-rable with those in general medicine (Leucht et al., 2012), the reductions in mortality and morbidity seen in cancer and cardiovascular disease over recent decades have proven more…”
Treatment strategies for ADHD: an evidence-based guide to select optimal treatment
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“Such ‘effect sizes’ seem comparable with, for example, sumatriptan for migraine, fluoxetine for major depressive disorder and cholinesterase inhibitors for dementia [18].”
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A Meta-Analysis of Placebo-Controlled Trials of Psychedelic-Assisted Therapy
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“According to a recent comparison of psychiatric and general medical treatments, around 27 (25, 33) patients with heart disease need to take statins to prevent one major cardiac event, while around 16 (13, 25) need to take ACE-inhibitors for one to avoid death from chronic heart failure (Leucht et al., 2012).”
BackgroundStratified medicine for mental disorders
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“Medication related somatic disorders Psychotropic drugs have proven to compare favourably with medications used in other fields of medicine with regards to effective clinical disease control (Leucht et al., 2012).”
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“Moreover, the observed SES with vortioxetine are consistent with, and similar to, those reported for many drugs used in general medical and psychiatric practice (e.g. paroxetine, fluoxetine, and lithium; Leucht et al., 2012), and in disorders of cognition (e.”
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“98 Those studies, however, usually have much larger sample sizes, increasing con fi dence in their estimates.”
BackgroundPersonalized prediction of antidepressant v. placebo response: evidence from the EMBARC study
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“…( d ∼ 0.30) (Kirsch et al ., 2008; Turner et al ., 2008; Fournier et al ., 2010; Khin et al ., 2011; Kirsch, 2015; Moncrieff and Kirsch, 2015; Cipriani et al ., 2018 ), and those observed between active treatments and controls from general medical contexts ( d ∼ 0.45) (Leucht et al ., 2012).”
BackgroundInfluentialMindfulness-based stress reduction for women diagnosed with breast cancer
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Gut Microbiota in Anxiety and Depression: Unveiling the Relationships and Management Options
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“However, the effectiveness of currently available antidepressant medications used in clinics for symptom relief and prevention seems inconsistent [16].”
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“Their point estimates of SMD were around 0.3, which is the same as antidepressants for depression, and indeed for many standard treatments in psychiatry and medicine (Leucht et al. 2012).”
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“A lot of suffering has been prevented and many diseases cured (51, 52).”
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“49) that was determined in a review of 33 psychopharmacological medications across all psychiatric disorders (Leucht et al., 2012).”
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“These effects are as dramatic as those of many other widely accepted treatments in general medicine [1].”
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Recovery from chronic fatigue syndrome after treatments given in the PACE trial
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“The NNT of 7 for recovery after both CBT and GET is within the range of the effects found for drug treatments in both general medical and psychiatric conditions (Leucht et al. 2012).”
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“A recent meta-analysis shows the results of psychiatric treatment to equal or surpass those of most medical specialties (13), but the treatments must be delivered to those who really need them, not squandered on those likely to do as well or better on their own.”
BackgroundEmotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review
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“These meta-analytic effect sizes are on the order of those found with antidepressant medications and, more compellingly, a range of currently available general psychiatric and general medicine prescription medications (Leucht et al., 2012).”
BackgroundHow effective are common medications: a perspective based on meta-analyses of major drugs
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“Furthermore, the effect sizes for negative symptoms reported here are higher than those of currently marketed drugs indicated for schizophrenia and ofmany drugs utilized to treat chronic diseases in general medicine (35).”
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“The limited empirical data on which strategy physicians use to match patients to antidepressants suggest that they consider 3 main factors: presence of specific target symptoms (particularly insomnia, anxiety, fatigue, or appetite changes); presence of comorbid conditions (particularly panic disorder, generalized anxi…”
InfluentialMann, K. F., Torup, L., Sørensen, P. S., Gual, A., Swift, R. M., Walker, B. M., & van den Brink, W. (2016) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2016.10.008 · Cited by 101
“However the effect sizes reported in the target population are well in the range for approved medicinal products in general medicine and psychiatry, including alcohol dependence (Leucht et al., 2012; Aubin et al., 2015).”
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“All included SSRIs and SNRIs showed greater reduction in overall psychopathology than placebo, with effect sizes comparable to those of other interventions in medicine [29].”
ResultTreatments for internet addiction, sex addiction and compulsive buying: A meta-analysis
Goslar, M., Leibetseder, M. M., Münch, H. M., Hofmann, S. G., & Laireiter, A. (2020) · Journal of Behavioral Addictions · doi:10.1556/2006.2020.00005 · Cited by 104
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Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review
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Citation Context Analysis as a Method for Conducting Rigorous and Impactful Literature Reviews
Anderson, M. H., & Lemken, R. K. (2020) · Organizational Research Methods · doi:10.1177/1094428120969905 · Cited by 83
Pharmacometabonomics and personalized medicine
Everett, J. R., Loo, R. L., & Pullen, F. S. (2013) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1177/0004563213497929 · Cited by 75
“The development of personalized healthcare is a necessary path for medicine to take, as it is increasingly clear that for many medicines, efficacy is only achieved in a subset of the patient population.(86) Equally, many otherwise efficacious medicines are withdrawn from the market because of safety concerns in a smal…”
BackgroundRecent advances in psychoradiology
Luo, L., You, W., DelBello, M. P., Gong, Q., & Li, F. Y. (2022) · Physics in Medicine and Biology · doi:10.1088/1361-6560/ac9d1e · Cited by 76
“Brain stimulation for precision treatment Evidence suggests that at present, existing pharmacological interventions for psychiatric disorders are often suboptimal (Leucht et al 2012).”
BackgroundQuintero, J., Gutiérrez-Casares, J. R., & Álamo, C. (2022) · Neurology and Therapy · doi:10.1007/s40120-022-00392-2 · Cited by 70
“Despite stimulant medications for ADHD being among the most effective drugs in psychiatry [36], there is a substantial placebo effect in subjects with ADHD [37], which could be explained by a synergy between placebo effects that influence the parent of the patient with ADHD and those acting on the clinician when inter…”
BackgroundDie Rolle von Placebo- und Nocebomechanismen bei depressiven Erkrankungen und ihrer Therapie
Rief, W. (2020) · Der Nervenarzt · doi:10.1007/s00115-020-00940-x · Cited by 70
Pharmacogenomics: A road ahead for precision medicine in psychiatry
Pardiñas, A. F., Owen, M. J., & Walters, J. (2021) · Neuron · doi:10.1016/j.neuron.2021.09.011 · Cited by 77
Sedgwick-Müller, J. A., Müller-Sedgwick, U., Adamou, M., Catani, M., Champ, R., Gudjónsson, G., Hank, D., Pitts, M., Young, S., & Asherson, P. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03898-z · Cited by 70
“Psychostimulant medications are among the most effective medications in use within adult mental health [89], and among the most efficacious of all common medical drugs [177].”
BackgroundUniversity students with attention deficit hyperactivity disorder (ADHD): a literature review
Sedgwick-Müller, J. A. (2017) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2017.20 · Cited by 74
“This is interesting in light of a study about the efficacy of psychiatric drugs in relation to common medical drugs, which found that ADHD medications are the most efficacious of all medical drugs (Leucht et al. 2012).”
BackgroundAre there meaningful biomarkers of treatment response for depression?
Breitenstein, B., Scheuer, S., & Holsboer, F. (2014) · Drug Discovery Today · doi:10.1016/j.drudis.2014.02.002 · Cited by 71
No role for initial severity on the efficacy of antidepressants: results of a multi-meta-analysis
Fountoulakis, K. Ν., Veroniki, A. A., Siamouli, M., & Möller, H. (2013) · Annals of General Psychiatry · doi:10.1186/1744-859x-12-26 · Cited by 67
“35 is a weak one and suggests that the treatment is not really working or it does not make any clinically relevant difference neglects the fact that such an effect size is the rule rather than the exception [54].”
Amitriptyline versus placebo for major depressive disorder
Leucht, C., Huhn, M., & Leucht, S. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009138.pub2 · Cited by 62
Self-citationReplication and contradiction of highly cited research papers in psychiatry: 10-year follow-up
Tajika, A., Ogawa, Y., Takeshima, N., Hayasaka, Y., & Furukawa, T. A. (2015) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.113.143701 · Cited by 64
Sinclair, J., Chambers, S. E., Shiles, C. J., & Baldwin, D. S. (2016) · Drug Safety · doi:10.1007/s40264-016-0416-y · Cited by 62
“Pharmacotherapy is underused in its treatment despite evidence of moderate effect [152], similar to that in other conditions [155].”
Biagianti, B., Fisher, M., Neilands, T. B., Loewy, R. L., & Vinogradov, S. (2016) · Neuropsychology · doi:10.1037/neu0000311 · Cited by 60
Are antidepressants overprescribed? Yes
Spence, D. (2013) · BMJ · doi:10.1136/bmj.f191 · Cited by 63
Sayer, N. A., Noorbaloochi, S., Frazier, P. A., Pennebaker, J. W., Orazem, R. J., Schnurr, P. P., Murdoch, M., Carlson, K. F., Gravely, A. A., & Litz, B. T. (2015) · Journal of Traumatic Stress · doi:10.1002/jts.22047 · Cited by 58
Tiihonen, J., Tanskanen, A., Hoti, F., Vattulainen, P., Taipale, H., Mehtälä, J., & Lähteenvuo, M. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30134-7 · Cited by 58
Leucht, S., Siafis, S., McGrath, J. J., McGorry, P. D., Howes, O. D., Tamminga, C. A., Carr, R., Bighelli, I., Schneider‐Thoma, J., Priller, J., et al. (2025) · Nature Reviews Disease Primers · doi:10.1038/s41572-025-00667-6 · Cited by 73
“The absolute difference compared with placebo (24% relapse versus 61% within 7–12 months) 255 is one of the largest in medicine 256 .”
Self-citationZink, M. (2014) · Advances in Medicine · doi:10.1155/2014/317980 · Cited by 55
A Neurodevelopment Approach for a Transitional Model of Early Onset Schizophrenia
Berardis, D. D., Filippis, S. D., Masi, G., Vicari, S., & Zuddas, A. (2021) · Brain Sciences · doi:10.3390/brainsci11020275 · Cited by 57
“The EPS are usually associated with high potency First Generation Antipsychotics (FGA) [119].”
BackgroundInfluentialEPA guidance on the role and responsibilities of psychiatrists
Bhugra, D., Ventriglio, A., Kuzman, M. R., Ikkos, G., Hermans, M., Falkai, P., Fiorillo, A., Musalek, M., Höschl, C., Dales, J., et al. (2015) · European Psychiatry · doi:10.1016/j.eurpsy.2015.02.002 · Cited by 52
“The role of the psychiatrist has also been described by the UEMS [26–28] in their Charter on Training of Medical Specialists in the European Union (requirements for the specialty of psychiatry).”
BackgroundInfluentialKaram, E. G., Karam, G. E., Farhat, C., Itani, L., Fayyad, J., Karam, A. N., Mneimneh, Z., Kessler, R., & Thornicroft, G. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796018000422 · Cited by 52
“Mental health treatment by specialists has progressed over the past decades with rigorous research studies designed to evaluate several aspects of the variety of treatments (mostly medical and psychological therapies including the use of modern technology) (Ginzburg et al., 2012; Leucht et al., 2012; Stott et al., 201…”
Backgroundde Vries, Y. A., de Jonge, P., van den Heuvel, E., Turner, E. H., & Roest, A. M. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.115.173450 · Cited by 50
Pharmacological Treatments for Disordered Gambling: A Meta-analysis
Goslar, M., Leibetseder, M. M., Münch, H. M., Hofmann, S. G., & Laireiter, A. (2018) · Journal of Gambling Studies · doi:10.1007/s10899-018-09815-y · Cited by 49
Peer support, self-determination, and treatment engagement: A qualitative investigation.
Jones, N., Corrigan, P. W., James, D., Parker, J., & Larson, N. (2013) · Psychiatric Rehabilitation Journal · doi:10.1037/prj0000008 · Cited by 50
Kaufman, J., Gelernter, J. E., Hudziak, J. J., Tyrka, A. R., & Coplan, J. D. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2015.06.001 · Cited by 46
Faraone, S. V., Newcorn, J. H., Cipriani, A., Brandeis, D., Kaiser, A., Hohmann, S., Haege, A., & Cortese, S. (2022) · Molecular Psychiatry · doi:10.1038/s41380-021-01134-w · Cited by 44
“The effects of stimulant medications for ADHD are among the highest in psychiatry and other areas of medicine [2].”
BackgroundDepression and suicidality in COPD: understandable reaction or independent disorders?
Hegerl, U., & Mergl, R. (2014) · European Respiratory Journal · doi:10.1183/09031936.00193213 · Cited by 43
Smith, R. C., Leucht, S., & Davis, J. M. (2019) · Psychopharmacology · doi:10.1007/s00213-018-5133-z · Cited by 41
Self-citationClinical Relevance of As-Needed Treatment with Nalmefene in Alcohol-Dependent Patients
Aubin, H., Reimer, J., Nutt, D., Bladström, A., Torup, L., François, C., & Chick, J. (2015) · European Addiction Research · doi:10.1159/000371547 · Cited by 40
Leucht, S., Chaimani, A., Leucht, C., Huhn, M., Mavridis, D., Helfer, B., Samara, M. T., Cipriani, A., Geddes, J. R., Salanti, G., et al. (2018) · Schizophrenia Research · doi:10.1016/j.schres.2018.05.009 · Cited by 40
Self-citationWallace, J., Byrne, C., & Clarke, M. J. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005834 · Cited by 41
“The aim here was to place the different interventions in perspective.(48) It is important to consider the target audience, their values and preferences while linking the key message to the level of the decisionmaker’s training.”
BackgroundBschor, T., & Kilarski, L. L. (2016) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2016.1155985 · Cited by 43
“and a NNT of 20 to prevent death or dependency after stroke by thrombolysis [19].”
BackgroundProgress and prospects in pharmacogenetics of antidepressant drugs
Fabbri, C., Crisafulli, C., Calabrò, M., Spina, E., & Serretti, A. (2016) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1080/17425255.2016.1202237 · Cited by 38
“general medical diseases [3], but high interindividual variability in response to antidepressants was reported.”
BackgroundConnolly, J. J., Glessner, J., Kao, C., Elia, J., & Hakonarson, H. H. (2015) · Therapeutic Innovation & Regulatory Science · doi:10.1177/2168479015599811 · Cited by 43
Metadata
- Authors
- Leucht, S., Hierl, S., Kissling, W., Dold, M., & Davis, J. M.
- Affiliations
- TUM Klinikum (DE)
- University of Illinois Chicago (US)
- Corresponding author
- Leucht, Stefan
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2012-02
- Volume
- 200
- Issue
- 2
- Pages
- 97-106
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2101652281
- Semantic Scholar
- 68218f1e65e6903db144e3aec0175e90671d7c26
- Cited by
- 451
- References
- 202
- Citations by year
- 2026: 22 · 2025: 30 · 2024: 31 · 2023: 21 · 2022: 28 · 2021: 33 · 2020: 38 · 2019: 40 · 2018: 28 · 2017: 30 · 2016: 23 · 2015: 41 · 2014: 39 · 2013: 28 · 2012: 16
- FWCI
- 10.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- psychotropic drugs, placebo response, effect size, adverse drug reactions
- MeSH terms
- Mental Disorders, Pharmaceutical Preparations, Humans, Placebos, Psychiatry, Psychotropic Drugs, Review Literature as Topic, Meta-Analysis as Topic, Bias, Databases, Bibliographic, Outcome Assessment, Health Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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