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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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ResultEPA guidance on improving the image of psychiatry
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“Interestingly, the effect size of antidepressants and other psychopharmaceuticals is on a comparable level as the effects of medications used in internal medicine [69], where none of this overcritical interrogation takes place.”
BackgroundSetting Health-Care Priorities
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The role of gut microbiota in the pathogenesis and treatment of postpartum depression
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“Not only is 0.875 considerably higher than effect sizes for most treatments used in psychiatry and general medicine (Leucht et al., 2012), it also implies that for antidepressants to be considered minimally efficacious, almost all patients treated with an antidepressant need to achieve remission…”
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“Lithium is one of the most effective treatments available not only in psychiatry, but in the whole medicine [25], and its clinical efficacy is superior to that of other mood stabilizers.”
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“…and lack of diagnostic tests, and the psychopharmacological treatments by their commercial conflict of interest, unclear mechanism of drug action and side-effects, however, at the same time, the efficacy of psychotropic drugs is supported by randomized controlled trials (Leucht et al., 2012).”
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“Indeed, psychostimulants are one of the most efficacious drugs in psychiatry and more generally in medicine [20].”
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Meling, D., Ehrenkranz, R. C., Nayak, S. M., Aicher, H., Funk, X., van Elk, M., Graziosi, M., Bauer, P. R., Scheidegger, M., & Yaden, D. B. (2024) · Psychoactives · doi:10.3390/psychoactives3020014 · Cited by 35
The unfulfilled promise of the antidepressant medications
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Writing therapy: a new tool for general practice?
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Specificity of CBT for Depression: A Contribution from Multiple Treatments Meta-analyses
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“…interval of their obtained effect size is very wide, surpassing 0.50, which signifies a moderate effect according to Cohen’s rule of thumb (Cohen 1988) and may, in fact, be more powerful than more than half of the established and currently practiced medical interventions (Leucht et al. 2012).”
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Cuijpers, P. J., Huibers, M. J. H., & Furukawa, T. A. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.4070 · Cited by 29
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Fountoulakis, K. Ν., Moeller, H.-J., Kasper, S. F., Tamminga, C. A., Yamawaki, S., Kahn, R. S., Tandon, R., Correll, C. U., & Javed, A. (2020) · CNS Spectrums · doi:10.1017/s1092852920001546 · Cited by 28
“The favorable efficacy of antipsychotics extends also into the early maintenance phase and up to 3 years after the acute episodewith numbers-needed-to-treat vs placebo for relapse prevention being as low as 3.(23,31,32) The data on antipsychotic efficacy are strong concerning total and positive symptoms, but equivocal…”
BackgroundAntipsychotic treatment: experiences of fully recovered service users
Bjørnestad, J. R., Davidson, L., Joa, I., Larsen, T. K., Hegelstad, W. T. V., Langeveld, J., Veseth, M., Melle, I. S., Johannessen, J. O., & Brønnick, K. (2017) · Journal of Mental Health · doi:10.1080/09638237.2017.1294735 · Cited by 30
“In this regard study findings, particularly with regard to long-term functional aspects of recovery, echo previous findings (Bola et al., 2011; Leucht et al., 2012a; Saha et al., 2016) in their call for large-scale independent trials in order to create a new and improved evidence base to…”
BackgroundInfluentialNatural Medicines for Psychotic Disorders
Hoenders, R. H. J., Bartels‐Velthuis, A. A., Vollbehr, N. K., Bruggeman, R., Knegtering, H., & de Jong, J. T. V. M. (2018) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000782 · Cited by 28
“Apart from clozapine, second-generation antipsychotics are generally as effective as first-generation antipsychotics for positive symptoms, but the promise of greater efficacy for negative symptoms has not been fulfilled (Leucht et al., 2012).”
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“From a health promotion perspective, this could be considered meaningful for improving mental health, particularly with the effectiveness of treatments in psychiatry and medicine for mental health often judged on whether a small intervention effect size is achieved.(77) Of note, similar findings to this review have be…”
ResultThe Impact of Psychopharmacology on Contemporary Psychiatry
Baldessarini, R. J. (2014) · The Canadian Journal of Psychiatry · doi:10.1177/070674371405900801 · Cited by 32
McCutcheon, R. A., Taylor, D. M., Rubio, J. M., Nour, J., Pillinger, T., Murray, R. M., & Jauhar, S. (2023) · Schizophrenia Bulletin · doi:10.1093/schbul/sbad139 · Cited by 26
Conduct and reporting of formula milk trials: systematic review
Helfer, B., Leonardi‐Bee, J., Mundell, A., Parr, C., Ierodiakonou, D., García-Larsen, V., Kroeger, C. M., Dai, Z., de Man, A. L., Jobson, J., et al. (2021) · BMJ · doi:10.1136/bmj.n2202 · Cited by 26
„Occupational eMental Health“ in der Lehrergesundheit
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Mental health stigma: the role of dualism, uncertainty, causation and treatability
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Antipsychotic drugs: challenges and future directions
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Approach to Evaluating and Managing Adult Attention-Deficit/Hyperactivity Disorder in Primary Care
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Statistical power in clinical trials of interventions for mood, anxiety, and psychotic disorders
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“We set SMD = 0.40 as the primary effect size in our study (i.e. the effect size of greatest interest), as this is close to the mean effect size for psychiatric treatments in general (Huhn et al., 2014; Leucht, Hierl, Kissling, Dold, & Davis, 2012).”
InfluentialSymptomatic versus disease‐modifying effects of psychiatric drugs
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“The absence of awareness of this distinction has led to mistaken claims, such as in a highly-cited meta-analysis.(20) That study compared effect sizes of antidepressants with those of drugs for other medical conditions like cardiovascular and infectious diseases.”
ResultPsychiatry and/or recovery: a critical analysis
Crowe, M. (2022) · International Journal of Mental Health Nursing · doi:10.1111/inm.13072 · Cited by 26
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Self-citationThe future of psychotherapy research: stop the waste and focus on issues that matter
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“The effect sizes found for treatments for mental disorders do not differ very much from those in general medical disorders (Leucht et al. 2012), but still it is estimated that current treatments cannot take away more than one-third of the disease burden of depression, and then only in optimal…”
BackgroundThe antidepressant standoff: Why it continues and how to resolve it
Ormel, J., Spinhoven, P., de Vries, Y. A., Cramer, A. O. J., Siegle, G. J., Bockting, C. L. H., & Hollon, S. D. (2020) · Psychological Medicine · doi:10.1017/s0033291719003295 · Cited by 22
“…general medicine drugs (e.g. ACE inhibitors and statins for prevention of cardiovascular events and stroke) ADM are not in general less efficacious (Leucht et al., 2012), although the clinical significance of a given effect size is context-dependent and may differ between psychiatry and general…”
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“Meta-analysis shows that the results of psychiatric treatment equal or surpass those of most medical specialties (7), but the treatments must be delivered to patients who really need them instead of being squandered on those likely to do well on their own.”
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“Moreover, with experience, and in common with most drugs in medicine, psychotropic agents old and new were recognised to have overall effects that were modest, because they were variable between individuals (GENDEP et al., 2013; Leucht et al., 2012).”
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“Diese Effektstärke gilt als niedrig, ist jedoch mit der Effektstärke zahlreicher gut etablierter medizinischer und psychopharmakologischer Behandlungen vergleichbar [Leucht et al., 2012].”
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The crisis in psychiatry: A public health perspective
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“They need to be convinced that interventions we have for treating mental disorders are among the most effective in medicine (Leucht et al., 2012).”
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Is metacognitive training for psychosis effective?
Moritz, S., Woodward, T. S., & Balzan, R. (2016) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2016.1135737 · Cited by 21
“While the effect size of MCT is comparable to that seen in CBT for psychosis [15], there is clearly room for improvement, particularly in view of a just moderate effect size available through antipsychotics [16].”
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“Leucht et al. (2012) found median SMDs compared with placebo for the most-frequently used medical drugs of SMD = 0.37 (SMD = 0.41 for psychopharmacological drugs).”
InfluentialThe role of psychiatry in modern medicine
Fiorillo, A., & Maj, M. (2018) · International Review of Psychiatry · doi:10.1080/09540261.2018.1436675 · Cited by 20
“They should know that the ‘psychiatric drugs’ are among the most effective medical drugs available (Leucht et al., 2012), instead of considering them as useless or even dangerous.”
BackgroundAttention deficit hyperactivity disorder in adults: What the non-specialist needs to know
Johnson, J., Morris, S., & George, S. (2020) · British Journal of Hospital Medicine · doi:10.12968/hmed.2019.0188 · Cited by 18
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“A recent systematic review suggests that the range of treatments available for mental and physical conditions, including those which may have long-term consequences, have essentially similar effect sizes [20].”
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Self-citationSchizophrenia, primary negative symptoms, and soft outcomes in psychiatry
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Self-citationEfficacy and acceptability of antidepressants in patients with ischemic heart disease
Ostuzzi, G., Turrini, G., Gastaldon, C., Papola, D., Rayner, L., Caruso, R., Grassi, L. G., Hotopf, M. H., & Barbui, C. (2018) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000248 · Cited by 18
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“For instance, psychostimulants for core symptoms of ADHD (Cortese, 2020) are the most efficacious medications, at least in the short-term, in psychiatry and among the most efficacious medications across all the medical disciplines (Leucht et al., 2012).”
Biomarkers for Psychosis: Are We There Yet? Umbrella Review of 1478 Biomarkers
Fuentes‐Claramonte, P., Estradé, A., Solanes, A., Ramella‐Cravaro, V., García‐León, M. Á., de Diego-Adeliño, J., Molins, C., Fung, E., Valentí, M., Anmella, G., et al. (2024) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgae018 · Cited by 25
“23,32 One obstacle for the translational potential of scientific findings is the fragmentation of knowledge as primary biomedical studies proliferate and diversify.”
BackgroundMaddukuri, R. K., Hema, C., Tejaswi, K. S., Mounika, M. V., & Vegesana, B. P. (2021) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2021.102866 · Cited by 18
Burning issues in the meta-analysis of pharmaceutical trials for depression
Fountoulakis, K. Ν., Samara, M. T., & Siamouli, M. (2013) · Journal of Psychopharmacology · doi:10.1177/0269881113504014 · Cited by 17
“However, such an interpretation neglects the fact that such an SMD is the rule rather than the exception not only in psychiatry, but also in medicine (Leucht et al., 2012; Seemuller et al., 2012).”
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Chu, L., Zhu, P., Ma, C., Pan, L., Shen, L., Wu, D., Wang, Y., & Yu, G. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2021.813305 · Cited by 21
Estimating the smallest worthwhile difference of antidepressants: a cross-sectional survey
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Self-citationFactors contributing to the increasing placebo response in antidepressant trials
Kasper, S. F., & Dold, M. (2015) · World Psychiatry · doi:10.1002/wps.20245 · Cited by 16
“It appears meaningful to emphasize that the drug-placebo contrast in long-term, relapse-prevention studies is usually higher compared to acutephase trials (8).”
ResultSelf-citationKetamine: Leading us into the future for development of antidepressants
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“Indeed Leucht and colleagues mention in their meta-analysis on maintenance therapy that an unpublished update on the depot versus oral meta-analysis shows no difference among the formulations [Leucht et al. 2012b].”
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“Actually, according to a recent review of meta-analyses (13), the efficacy of antipsychotics in the acute treatment of schizophrenia, as assessed by the standardized mean difference from placebo, is similar to that of antihypertensives in the treatment of hypertension and of corticosteroids in the treatment of asthma.”
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“Where some argue that their efficacy is supported by randomized controlled trials [135], others state that it is unlikely that there is a clinically important advantage for antidepressants over placebos in individuals with minor depression [126, 136-139].”
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“Furthermore, when comparing the effect sizes obtained from recent placebo-controlled antipsychotic and antidepressant trials with those of older studies, clinicians can get the impression that the newer marked psychiatric drugs are less potent than the older ones or even that the older drugs have lost efficacy over th…”
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Transforming the evidence landscape in mental health with platform trials
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“A detailed description of these trials is provided in Box 1. demonstrated that most trials are substantially underpowered 5 to detect the effect sizes that one can reasonably expect from them 6 .”
Is there compelling evidence that schizophrenia long‐term treatment guidelines should be changed?
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Should We Use Expired Drugs When Necessary?
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Pharmakotherapie der Alkoholentwöhnung: Update und neue Entwicklungen
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Effects of Antipsychotic Treatment on Obsessive-Compulsive Symptoms
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“Actually, a recent review of meta-analyses (8) documented that antipsychotics, antidepressants and mood stabilizers are at least as efficacious (on their target conditions) as many drugs used by the other branches of medicine, when the reference measure is the standardized mean difference from placebo.”
BackgroundThe Modern Psychiatrist’s Guide to Contemporary Practice
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“On the other hand, the effect size found in agomelatine seems to be higher than other drugs in different health conditions, such as ACE inhibitors in preventing cardiovascular events and acute stroke (effect size = 0.16 and 0.11, respectively) [50].”
BackgroundInfluentialDo we underestimate the benefits of antidepressants?
Adli, M., & Hegerl, U. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60534-1 · Cited by 10
Jauhar, S., & Lawrie, S. M. (2022) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00293-5 · Cited by 10
Medical Needs in the Treatment of Psychotic Disorders
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“96.(2,3) Yet, it is also known that there is individual variation in response to MPH among ADHD children with a minority, up to 20%–30%, reporting milder or little improvement.”
BackgroundResult
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
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