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Cited by 55Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

The efficacy of paroxetine and placebo in treating anxiety and depression: a meta-analysis of change on the hamilton rating scales

Open access
Sugarman, Michael A., Loree, Amy M., Baltes, Boris B., Grekin, Emily R., Kirsch, Irving·2014·PLoS ONE
DOI 10.1371/journal.pone.0106337PMC PMC4146610
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Abstract

BACKGROUND: Previous meta-analyses of published and unpublished trials indicate that antidepressants provide modest benefits compared to placebo in the treatment of depression; some have argued that these benefits are not clinically significant. However, these meta-analyses were based only on trials submitted for the initial FDA approval of the medication and were limited to those aimed at treating depression. Here, for the first time, we assess the efficacy of a selective serotonin reuptake inhibitor (SSRI) in the treatment of both anxiety and depression, using a complete data set of all published and unpublished trials sponsored by the manufacturer. METHODS AND FINDINGS: GlaxoSmithKline has been required to post the results for all sponsored clinical trials online, providing an opportunity to assess the efficacy of an SSRI (paroxetine) with a complete data set of all trials conducted. We examined the data from all placebo-controlled, double-blind trials of paroxetine that included change scores on the Hamilton Rating Scale for Anxiety (HRSA) and/or the Hamilton Rating Scale for Depression (HRSD). For the treatment of anxiety (k = 12), the efficacy difference between paroxetine and placebo was modest (d = 0.27), and independent of baseline severity of anxiety. Overall change in placebo-treated individuals replicated 79% of the magnitude of paroxetine response. Efficacy was superior for the treatment of panic disorder (d = 0.36) than for generalized anxiety disorder (d = 0.20). Published trials showed significantly larger drug-placebo differences than unpublished trials (d's = 0.32 and 0.17, respectively). In depression trials (k = 27), the benefit of paroxetine over placebo was consistent with previous meta-analyses of antidepressant efficacy (d = 0.32). CONCLUSIONS: The available empirical evidence indicates that paroxetine provides only a modest advantage over placebo in treatment of anxiety and depression. Treatment implications are discussed.

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  1. [11]Meier B (2004) Glaxo begins posting drug trial results. New York: New York Times. Available: http://www.nytimes.com/2004/09/01/business/01registry.html?_r=0. Accessed 31 October 2013. 15709258
  2. [32]Lipsey MW, Wilson DB (2001) Practical meta-analysis (applied social research methods). Thousand Oaks, CA: Sage Publications.
  3. [34]Hedges LV, Olkin I (1985) Statistical methods for meta-analysis. New York, NY: Academic Press. 369 p.
  4. [42]National Center for Health & Clinical Excellence (2010) Depression: The treatment and management of depression in adults (updated edition). London: The British Psychological Society and The Royal College of Psychiatrists. 705 p. 22132433

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Authors
Sugarman, M. A., Loree, A. M., Baltes, B. B., Grekin, E. R., & Kirsch, I.
Affiliations
  • Wayne State University (US)
  • Harvard University (US)
Corresponding author
Sugarman, Michael A.
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2014-08-27
Volume
9
Issue
8
Pages
e106337
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0106337
PMC
PMC4146610
OpenAlex
W2163900708
Cited by
55
References
90
Citations by year
2025: 5 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 3 · 2020: 6 · 2019: 4 · 2018: 8 · 2017: 7 · 2016: 4 · 2015: 4
FWCI
0.64
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
paroxetine, selective serotonin reuptake inhibitors, anxiety disorders, depression, placebo response, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, panic disorder, generalized anxiety disorder, unpublished clinical trials, antidepressant efficacy
MeSH terms
Anxiety, Anxiety Disorders, Clinical Trials as Topic, Depression, Double-Blind Method, Humans, Placebos, Psychiatric Status Rating Scales, Severity of Illness Index, Panic Disorder, Treatment Outcome, Paroxetine, Antidepressive Agents, Second-Generation

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